Claim total
$538.47
base $127.17 · payer covered $488.47
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Injury of knee125601008
- Start
- 2025-12-01
- Stop
- 2025-12-01
The parties
- Patient
- patient Preston Gino Ebert
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
185c39dc-d484-8161-04dd-5589379638e7