Claim total
$511.57
base $93.39 · payer covered $461.57
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2018-12-04
- Stop
- 2018-12-04
The parties
- Patient
- patient Matt Stanton Brown
- Provider
- provider Kaitlyn Ullrich
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
04e52287-fbd6-ff57-9d1b-3ebec3323591