Claim total
$4,854.63
base $127.17 · payer covered $4,819.63
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2001-04-12
- Stop
- 2001-04-12
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-c3d4-4492e40ba243