Claim total
$538.47
base $127.17 · payer covered $488.47
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Injury of knee125601008
- Start
- 2025-07-28
- Stop
- 2025-07-28
The parties
- Patient
- patient Libby Celine Gorczany
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Medicaid
Record id
369882ce-78fe-11ba-4301-4eba1bff9939