Claim total
$1,247.17
base $93.39 · payer covered $1,197.17
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2002-04-04
- Stop
- 2002-04-04
The parties
- Patient
- patient Santa Antonina Bernier
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
051f1153-ae45-1425-505c-49640ebfad76