Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2020-10-29
- Stop
- 2020-10-29
The parties
- Patient
- patient Kazuko Tamie Tillman
- Provider
- provider Bennie Gutkowski
- Care site
- care site FAIRVIEW UNIVERSITY TRANS SERV
- Payer
- payer Medicare
Record id
3487d097-833b-5fcf-4c74-399a2a621530