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
- 2019-11-16
- Stop
- 2019-11-16
The parties
- Patient
- patient Kiley Maisie Casper
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Medicaid
Record id
0a1845ad-d6fc-6e22-02dd-972a9c0f9b2e