Claim total
$140.99
base $93.39 · payer covered $90.99
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2026-02-28
- Stop
- 2026-02-28
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-c7c1-afb766303160