Claim total
$3,935.75
base $127.17 · payer covered $3,148.60
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2021-08-30
- Stop
- 2021-08-30
The parties
- Patient
- patient Ione Yahaira Glover
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer UnitedHealthcare
Record id
21ffffe4-f03e-a436-3c66-ab0038e2cfa5