Claim total
$372.32
base $93.39 · payer covered $322.32
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2021-03-03
- Stop
- 2021-03-03
The parties
- Patient
- patient Amanda Rheba Mitchell
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
0363ed75-83f4-7675-44b2-22ef5ba5499a