Claim total
$1,274.24
base $93.39 · payer covered $1,224.24
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- diagnosis concept Chronic congestive heart failure88805009
- Start
- 2015-10-14
- Stop
- 2015-10-14
The parties
- Patient
- patient Quintin Loyd Ullrich
- Provider
- provider Elvis Lebsack
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
33a68753-f79f-bb9d-0f36-b851e3d0d7ac