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
- 2025-09-06
- Stop
- 2025-09-06
The parties
- Patient
- patient Jerome Kohler
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Medicare
Record id
2feabf77-27d8-4e25-9003-b48d07682d92