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
- 2025-09-15
- Stop
- 2025-09-15
The parties
- Patient
- patient Vonnie Hagenes
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Medicaid
Record id
1ad40c04-b9e4-74d8-793c-c710193341b6