Claim total
$219.95
base $93.39 · payer covered $184.95
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2018-02-16
- Stop
- 2018-02-16
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
0465c17f-66cb-2155-2d43-45c532c2dc75