Claim total
$9,587.76
base $127.17 · payer covered $9,552.76
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2026-01-30
- Stop
- 2026-01-30
The parties
- Patient
- patient Brock Josiah Gaylord
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Dual Eligible
Record id
2d5d1e2a-d4d9-a177-0ede-cc4a2a78fac4