Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Burn injury48333001
- Start
- 2019-09-21
- Stop
- 2019-09-21
The parties
- Patient
- patient Kallie Jordan Sporer
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Dual Eligible
Record id
0a66253b-4906-0aa6-9853-2e72f3b0d5d3