Claim total
$949.77
base $127.17 · payer covered $847.37
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2026-06-24
- Stop
- 2026-06-24
The parties
- Patient
- patient Sina Meda Ritchie
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Medicaid
Record id
1ce047fe-58bf-bac6-9c4c-c490f394e9f1