Claim total
$111.12
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-11-28
- Stop
- 2025-11-28
The parties
- Patient
- patient Marilynn Jaimie Pouros
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
0126af27-a469-d3f6-87ce-b678c6c3c8c6