Claim total
$93.39
base $93.39 · payer covered $43.39
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2014-05-04
- Stop
- 2014-05-04
The parties
- Patient
- patient Adrian Arden Haag
- Provider
- provider Joshua Dickens
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
341d0f9d-7d8e-e18c-dc40-dd9cff32c9e8