Claim total
$811.53
base $93.39 · payer covered $761.53
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2024-05-13
- Stop
- 2024-05-14
The parties
- Patient
- patient Elliott Crooks
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
016f6acf-14e3-04d0-e058-caf9b2d62110