Claim total
$1,145.58
base $93.39 · payer covered $687.34
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- diagnosis concept Chronic congestive heart failure88805009
- Start
- 1997-03-25
- Stop
- 1997-03-25
The parties
- Patient
- patient Jacqulyn Lavonna Legros
- Provider
- provider Tiffany Sauer
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Humana
Record id
28e07049-ca1f-fcfe-b1cb-8c52bb954cba