Claim total
$4,431.70
base $127.17 · payer covered $4,381.70
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2017-03-03
- Stop
- 2017-03-03
The parties
- Patient
- patient Myles Kristofer Kub
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
22e8a807-5128-01a6-ef45-8f67d25f9309