Claim total
$93.39
base $93.39 · payer covered $43.39
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2021-07-06
- Stop
- 2021-07-06
The parties
- Patient
- patient Amy Irena Jacobi
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
0c24ce21-5059-79dc-c3c7-15b9355bbb87