Claim total
$12,771.48
base $127.17 · payer covered $6,040.55
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2018-10-25
- Stop
- 2018-10-25
The parties
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
Record id
1d976b23-0166-2107-d050-dd0556d7e5d8