Claim total
$978.26
base $155.66 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2026-04-18
- Stop
- 2026-04-18
The parties
- Patient
- patient Angele Khalilah Kuphal
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer No insurance
Record id
044947be-396f-8eb7-c189-ae84ab15fa8c