Claim total
$4,733.88
base $127.17 · payer covered $3,787.06
The visit
- Class
- Inpatient
- Code
- 305351004
- Reason
- diagnosis concept Chronic congestive heart failure88805009
- Start
- 2013-06-16
- Stop
- 2013-06-18
The parties
- Patient
- patient Sang Raymundo Wolff
- Provider
- provider Tiffany Sauer
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
0c6ad717-8d19-38b7-312d-7269ade63f18