Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2026-04-02
- Stop
- 2026-04-02
The parties
- Patient
- patient Jose Tanner Jakubowski
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer UnitedHealthcare
Record id
17e9a58b-659f-915c-d0e2-b1bcd3c2cc8f