Claim total
$1,361.07
base $127.17 · payer covered $1,326.07
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of mandible263172003
- Start
- 1980-02-17
- Stop
- 1980-02-17
The parties
- Patient
- patient Arnold O'Keefe
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
265323f0-0943-a199-4216-9d1e30d6f324