Claim total
$3,935.75
base $127.17 · payer covered $3,935.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2025-01-08
- Stop
- 2025-01-08
The parties
- Patient
- patient Mariann Tennie Dooley
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
1b992c53-6e6f-6996-2d0d-c4166f499631