Claim total
$122.72
base $93.39 · payer covered $73.63
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2016-02-28
- Stop
- 2016-02-28
The parties
- Patient
- patient Leo Ramon Wolf
- Provider
- provider Enoch Torp
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Aetna
Record id
0132d8d5-6e6e-d90f-d90d-9b5dc94b0b9f