Claim total
$75.00
base $75.00 · payer covered $25.00
The visit
- Class
- Virtual
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2020-04-13
- Stop
- 2020-04-13
The parties
- Patient
- patient Leilani Melany Kuvalis
- Provider
- provider Kiyoko Predovic
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
222da595-6329-b84e-608f-f99a19eabffb