Claim total
$19,685.62
base $155.66 · payer covered $19,635.62
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2018-04-04
- Stop
- 2018-04-04
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-ecc6-21c0d30af3ba