Claim total
$6,226.77
base $127.17 · payer covered $6,191.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2008-09-22
- Stop
- 2008-09-22
The parties
- Patient
- patient Orval Hershel Dietrich
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Dual Eligible
Record id
1a1f128e-0964-8a74-5190-dca33a3f0ef2