Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2021-05-19
- Stop
- 2021-05-19
The parties
- Patient
- patient Fermin Fritsch
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer No insurance
Record id
1fd8edbf-4736-d906-cf9e-f6263d51947a