Claim total
$12,680.66
base $155.66 · payer covered $12,630.66
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2017-06-12
- Stop
- 2017-06-12
The parties
- Patient
- patient Cecilia Botsford
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
046c8377-6cc1-c8f9-919a-e1b873d365d3