Claim total
$108.84
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-07-12
- Stop
- 2025-07-12
The parties
- Patient
- patient Leslee Christiansen
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Anthem
Record id
01280686-ae2e-42f0-2567-67fd9ffe4aa5