Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2026-04-10
- Stop
- 2026-04-10
The parties
- Patient
- patient Malvina Jodie Funk
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
3566cc77-5678-10db-81f5-6ab71ed49e8a