Claim total
$147.02
base $93.39 · payer covered $97.02
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-02-07
- Stop
- 2025-02-07
The parties
- Patient
- patient Danial Hal Lang
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
06067a48-9015-34d7-e71a-905ed492aa1c