Claim total
$5,040.24
base $127.17 · payer covered $4,990.24
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2023-05-26
- Stop
- 2023-05-26
The parties
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
2b201776-a170-1a2d-3287-93c1282ff08a