Claim total
$219.95
base $93.39 · payer covered $169.95
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2025-07-13
- Stop
- 2025-07-13
The parties
- Patient
- patient Cathryn Kandy Smith
- Provider
- provider Georgetta Kohler
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
038ad96a-9908-2f0d-9a2e-b3ef522d598b