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
- 2009-06-07
- Stop
- 2009-06-07
The parties
- Patient
- patient Yvonne Ondricka
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer UnitedHealthcare
Record id
2651fa10-73ce-522f-a931-dc9e071e662e