Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2025-12-14
- Stop
- 2025-12-14
The parties
- Patient
- patient Hans Matthew Klocko
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer Humana
Record id
0dcefe69-a1de-dc0d-dd6c-0f7341de6e4f