Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2022-11-05
- Stop
- 2022-11-05
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-b73d-662804defbd7