Claim total
$566.96
base $155.66 · payer covered $416.96
The visit
- Class
- Ambulatory
- Code
- 170837001
- Reason
- Allergic disposition609328004
- Start
- 2017-12-12
- Stop
- 2017-12-12
The parties
- Patient
- patient Jimmy Leland Hermiston
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
34ccec67-7080-7434-4ef5-6cdd84d2364f