Claim total
$107.74
base $93.39 · payer covered $57.74
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2023-10-12
- Stop
- 2023-10-12
The parties
- Patient
- patient Johnnie Rashad Pfeffer
- Provider
- provider Mario Wilkinson
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
030fbd6c-bbe4-c142-f29b-7799ac99c6e1