Claim total
$96.45
base $93.39 · payer covered $46.45
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2020-06-07
- Stop
- 2020-06-07
The parties
- Patient
- patient Danyell Anya Gislason
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
00b8faa9-dae2-fa2d-08ca-cf298dab1bf2