Claim total
$949.77
base $127.17 · payer covered $914.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2023-03-03
- Stop
- 2023-03-03
The parties
- Patient
- patient Adena Noemi Effertz
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Dual Eligible
Record id
2804fa6c-2718-80c4-63ee-8154d4ca20b7