Claim total
$949.77
base $127.17 · payer covered $424.44
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2025-03-18
- Stop
- 2025-03-18
The parties
- Patient
- patient Jose Tanner Jakubowski
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer UnitedHealthcare
Record id
17e9a58b-659f-915c-7e4b-8d96a1d45313