Claim total
$219.95
base $93.39 · payer covered $169.95
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2019-05-08
- Stop
- 2019-05-08
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Burton O'Conner
- Payer
- payer Medicaid
Record id
0274bb53-c777-eb96-5eb7-a339ac028111