Claim total
$5,632.51
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2026-02-11
- Stop
- 2026-02-11
The parties
- Patient
- patient Erna Gayla Mayert
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
30cfe8d1-eb95-8f71-9f4e-45233154bb0c