Claim total
$3,935.75
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2026-09-05
- Stop
- 2026-09-05
The parties
- Patient
- patient Del Lueilwitz
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Aetna
Record id
1591acd8-0c3e-6a58-0536-a8288bf730a9