Claim total
$15,289.66
base $127.17 · payer covered $15,239.66
The visit
- Class
- Inpatient
- Code
- 32485007
- Start
- 2024-12-05
- Stop
- 2024-12-07
The parties
- Patient
- patient Branden Milford Ullrich
- Provider
- provider Tiffany Sauer
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
10ef12fb-14dc-88af-9512-ea9d1e75a04e