Claim total
$115.49
base $93.39 · payer covered $65.49
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2020-03-26
- Stop
- 2020-03-26
The parties
- Patient
- patient Johnnie Rashad Pfeffer
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
030fbd6c-bbe4-c142-9b85-31c0388c9c7a