Claim total
$12,440.03
base $127.17 · payer covered $4,426.01
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2017-12-19
- Stop
- 2017-12-20
The parties
- Patient
- patient Jerome Kohler
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Humana
Record id
2feabf77-27d8-4e25-a4e6-3abb07053da0