Claim total
$6,905.27
base $155.66 · payer covered $6,855.27
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2025-04-02
- Stop
- 2025-04-02
The parties
- Patient
- patient Royce Peter Wolf
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
04658673-6112-6940-6993-f2a1750bf2fa