Claim total
$806.07
base $93.39 · payer covered $756.07
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2015-03-07
- Stop
- 2015-03-07
The parties
- Patient
- patient Zachery Vincenzo Berge
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
01ce818c-8f9f-924a-94fb-7fac86a66d40