Claim total
$13,792.46
base $127.17 · payer covered $13,742.46
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Acute cholecystitis65275009
- Start
- 2022-06-19
- Stop
- 2022-06-20
The parties
- Patient
- patient Simona Abbey Hodkiewicz
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
28cc646f-6044-8ac8-8ffa-b8faa12e3c2c