Claim total
$133.56
base $93.39 · payer covered $83.56
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2004-06-15
- Stop
- 2004-06-15
The parties
- Patient
- patient Leigh Weston Lubowitz
- Provider
- provider Wan Osinski
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
0031d341-6ceb-7483-4176-2bdf24755900