Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2017-12-18
- Stop
- 2017-12-18
The parties
- Patient
- patient Mitch Trey Leannon
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
17228e98-12bd-8e80-00b7-bbc075007dd3