Claim total
$949.77
base $127.17 · payer covered $914.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2017-05-20
- Stop
- 2017-05-20
The parties
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
2b999228-9ebb-3076-8f5d-76ebf613c957