Claim total
$219.95
base $93.39 · payer covered $169.95
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2020-07-07
- Stop
- 2020-07-07
The parties
- Patient
- patient Cathryn Kandy Smith
- Provider
- provider Garret Mohr
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
038ad96a-9908-2f0d-13a5-5cf174bc69c7