Claim total
$3,870.80
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 1975-05-01
- Stop
- 1975-05-01
The parties
- Patient
- patient Alton Patrick Dooley
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
3443265b-cbf5-d172-4905-9fde028c77dd