Claim total
$219.95
base $93.39 · payer covered $169.95
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2022-04-01
- Stop
- 2022-04-01
The parties
- Patient
- patient Wilson Teodoro Kihn
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
04540647-5ff4-de4a-a2e2-0a1d6fc0f672