Claim total
$260.78
base $93.39 · payer covered $210.78
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2022-01-09
- Stop
- 2022-01-09
The parties
- Patient
- patient Ines Jose Greenfelder
- Provider
- provider Mario Wilkinson
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
025967b2-09e2-065d-30ac-d2073774f871