Claim total
$480.31
base $93.39 · payer covered $430.31
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2018-10-18
- Stop
- 2018-10-18
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-fca5-e2738b0daaca