Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Burn injury48333001
- Start
- 2017-01-02
- Stop
- 2017-01-02
The parties
- Patient
- patient Shanelle Neomi Labadie
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
2d4a29d8-843f-44db-6898-cd6b74ceb220