Claim total
$4,854.63
base $127.17 · payer covered $3,778.11
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 1997-12-30
- Stop
- 1997-12-30
The parties
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Medicare
Record id
14f87ac6-4d7d-9114-a459-0ef66220e7bc