Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2025-12-14
- Stop
- 2025-12-14
The parties
- Patient
- patient Martin Chong Gerhold
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
2a9287c4-7bdc-d5bc-5ba0-72ac90c5fd4b