Claim total
$219.95
base $93.39 · payer covered $184.95
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2024-05-29
- Stop
- 2024-05-29
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Trinity Mraz
- Payer
- payer Dual Eligible
Record id
0274bb53-c777-eb96-b3c4-e925c79edbe4