Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2025-01-04
- Stop
- 2025-01-04
The parties
- Patient
- patient Elenore Astrid Ryan
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Aetna
Record id
2b192cee-fe62-521f-7605-f8503fa6da2c