Claim total
$132.66
base $93.39 · payer covered $82.66
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2020-01-05
- Stop
- 2020-01-05
The parties
- Patient
- patient Ines Jose Greenfelder
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
025967b2-09e2-065d-39db-e1fa9dd2dd39