Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2025-09-13
- Stop
- 2025-09-13
The parties
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
0f986608-7a32-b945-f029-a69908e154f7