Claim total
$219.95
base $93.39 · payer covered $184.95
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2021-01-27
- Stop
- 2021-01-27
The parties
- Patient
- patient Jewel Chi Harris
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Dual Eligible
Record id
05c57aa9-c3e8-2f04-bc81-9a9030f21d45