Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2026-04-09
- Stop
- 2026-04-09
The parties
- Patient
- patient Drew Brant Windler
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer UnitedHealthcare
Record id
24d7737b-1b1c-4b2b-9636-6b4fb0d05333