Claim total
$93.39
base $93.39 · payer covered $43.39
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2013-08-09
- Stop
- 2013-08-09
The parties
- Patient
- patient Dusty Tyson Heidenreich
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
2cd4188f-31dd-c72f-6215-004cbd24e6d6