Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2001-04-13
- Stop
- 2001-04-13
The parties
- Patient
- patient Analisa Willene Ebert
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Medicaid
Record id
21dda56e-f339-c75d-ac24-6a7176c084ae