Claim total
$19,588.09
base $127.17 · payer covered $19,538.09
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2018-08-02
- Stop
- 2018-08-02
The parties
- Patient
- patient Jennine Randy Von
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
22062255-770f-07d5-78cc-f0a0b25096ca