Claim total
$2,152.05
base $127.17 · payer covered $2,102.05
The visit
- Class
- Inpatient
- Code
- 305432006
- Reason
- diagnosis concept Awaiting transplantation of kidney698306007
- Start
- 2009-02-25
- Stop
- 2009-02-28
The parties
- Patient
- patient Sidney Champlin
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
33cb6c8c-a991-8f91-f73d-0c3d85a2eeb0