Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 2019-12-31
- Stop
- 2019-12-31
The parties
- Patient
- patient Fausto Jermaine Rice
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
22582bf2-69a5-1fcf-9b65-001a9e614d93