Claim total
$13,669.01
base $127.17 · payer covered $13,619.01
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 1998-05-17
- Stop
- 1998-05-17
The parties
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Medicaid
Record id
193e4bb3-7266-1ac6-9029-bea52d113751