Claim total
$219.95
base $93.39 · payer covered $169.95
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2016-05-21
- Stop
- 2016-05-21
The parties
- Patient
- patient María del Carmen Berríos
- Provider
- provider Rosina Schaden
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
016a1a5e-4450-7aaa-bc51-f777d99eef4b