Claim total
$93.39
base $93.39 · payer covered $43.39
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2015-12-13
- Stop
- 2015-12-13
The parties
- Patient
- patient Jesse Roosevelt Wolf
- Provider
- provider Letisha Graham
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
26aa011e-0d75-d1a3-34e3-e9b20225f91d