Claim total
$1,138.67
base $93.39 · payer covered $1,088.67
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- diagnosis concept Anemia271737000
- Start
- 2026-03-21
- Stop
- 2026-03-21
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-c49a-c6ae0d7cd4cf