Claim total
$120.27
base $93.39 · payer covered $120.27
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2015-12-13
- Stop
- 2015-12-13
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Ines Kautzer
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-8dcd-1a8c519a0b42