Claim total
$390.44
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2018-01-26
- Stop
- 2018-01-26
The parties
- Patient
- patient Cristina Caridad Salcedo
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
031e24ca-9978-b353-040a-24d2c6fc767d