Claim total
$219.95
base $93.39 · payer covered $169.95
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2026-01-15
- Stop
- 2026-01-15
The parties
- Patient
- patient Joe Maximo Kozey
- Provider
- provider Catalina Weimann
- Care site
- care site MERCY HOSPITAL
- Payer
- payer Medicaid
Record id
0135e6bd-cd4d-6318-7d6e-6189a63a3280