Claim total
$12,306.71
base $155.66 · payer covered $12,256.71
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2018-03-10
- Stop
- 2018-03-10
The parties
- Patient
- patient Cecilia Botsford
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
046c8377-6cc1-c8f9-4dca-7c109b4f7ec8