Claim total
$194.95
base $93.39 · payer covered $144.95
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2015-05-04
- Stop
- 2015-05-05
The parties
- Patient
- patient Elliott Crooks
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
016f6acf-14e3-04d0-0dc0-345e7ce141ed