Claim total
$4,992.38
base $127.17 · payer covered $2,995.43
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2025-01-21
- Stop
- 2025-01-21
The parties
- Patient
- patient Dale Kelly Heller
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Aetna
Record id
1b3472b4-114e-197d-4e14-44d8768aa2a4