Claim total
$7,638.33
base $127.17 · payer covered $7,603.33
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2025-07-04
- Stop
- 2025-07-04
The parties
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Dual Eligible
Record id
2afddf9a-fee1-f9d5-a275-183a1da36781