Claim total
$3,935.75
base $127.17 · payer covered $3,885.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2017-05-31
- Stop
- 2017-05-31
The parties
- Patient
- patient Elenore Astrid Ryan
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Medicaid
Record id
2b192cee-fe62-521f-ef76-08b00848bb92