Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2025-10-03
- Stop
- 2025-10-03
The parties
- Patient
- patient Ronnie Cristopher Kuphal
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
33a05bd5-edb9-cc9d-7999-784954c40f02