Claim total
$4,762.26
base $127.17 · payer covered $4,712.26
The visit
- Class
- Inpatient
- Code
- 305351004
- Reason
- diagnosis concept Chronic congestive heart failure88805009
- Start
- 2018-12-15
- Stop
- 2018-12-18
The parties
- Patient
- patient Lynn Catrina Keebler
- Provider
- provider Tiffany Sauer
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
1ce83e5f-4669-f644-76f9-77a756cee62e