Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2000-07-20
- Stop
- 2000-07-20
The parties
- Patient
- patient Enid Ignacia Barrows
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Dual Eligible
Record id
2619cead-04c9-109e-3116-b40a9c354427