Claim total
$949.77
base $127.17 · payer covered $899.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2026-07-07
- Stop
- 2026-07-08
The parties
- Patient
- patient Dwain Colin Simonis
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0ed9a3cf-eb03-2b47-c06a-67ad13e43b87