Claim total
$93.40
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2024-12-30
- Stop
- 2024-12-30
The parties
- Patient
- patient Bo Gino Murazik
- Provider
- provider Rosina Schaden
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
003af57f-1886-144b-bf2c-992bba634403