Claim total
$16,623.88
base $127.17 · payer covered $13,299.11
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2024-01-13
- Stop
- 2024-01-13
The parties
- Patient
- patient Thaddeus Kennith Pouros
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
150d2bd4-42df-badc-8df5-be068d04ea29