Claim total
$3,879.51
base $127.17 · payer covered $3,103.59
The visit
- Class
- Inpatient
- Code
- 305351004
- Reason
- diagnosis concept Chronic congestive heart failure88805009
- Start
- 1998-03-20
- Stop
- 1998-03-21
The parties
- Patient
- patient Jacqulyn Lavonna Legros
- Provider
- provider Tiffany Sauer
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
28e07049-ca1f-fcfe-d662-df3b1fbf3d4b