Claim total
$949.77
base $127.17 · payer covered $759.82
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2025-09-27
- Stop
- 2025-09-27
The parties
- Patient
- patient Hubert Carey Donnelly
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Medicare
Record id
2d78cd30-6b9a-db6f-0b8a-305fb836c504