Claim total
$188.55
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2015-07-19
- Stop
- 2015-07-19
The parties
- Patient
- patient Leo Ramon Wolf
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Aetna
Record id
0132d8d5-6e6e-d90f-deb1-04e02a326a9d