Claim total
$109.13
base $93.39 · payer covered $59.13
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2017-06-21
- Stop
- 2017-06-22
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Mario Wilkinson
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
03ef4f74-940b-d219-5664-084276e66ac3