Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-06-12
- Stop
- 2021-06-12
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-fc3f-92448f096620