Claim total
$9,094.75
base $127.17 · payer covered $9,059.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2025-02-19
- Stop
- 2025-02-19
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-a533-5dc591e5a5c0