Claim total
$15,361.54
base $127.17 · payer covered $15,326.54
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2023-12-23
- Stop
- 2023-12-23
The parties
- Patient
- patient Quinton Lueilwitz
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
19beb540-4cdd-68a1-3505-290b65229b7c