Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-10-18
- Stop
- 2021-10-18
The parties
- Patient
- patient Elliott Crooks
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
016f6acf-14e3-04d0-27bf-a4de4af38351