Claim total
$1,462.09
base $93.39 · payer covered $1,462.09
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 1980-12-19
- Stop
- 1980-12-19
The parties
- Patient
- patient Raye Suzy Gusikowski
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
02c06e54-48b8-2b73-f21d-0d313076d614