Claim total
$949.77
base $127.17 · payer covered $759.82
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2022-04-18
- Stop
- 2022-04-18
The parties
- Patient
- patient Dominga Sipes
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
2d091fb5-4e8b-bc96-cc17-9927d14f9d85