Claim total
$15,023.90
base $155.66 · payer covered $14,973.90
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2016-12-04
- Stop
- 2016-12-04
The parties
- Patient
- patient Cecilia Botsford
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
046c8377-6cc1-c8f9-7664-123c95efdf19