Claim total
$419.72
base $93.39 · payer covered $369.72
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2021-12-29
- Stop
- 2021-12-29
The parties
- Patient
- patient Deirdre Shannon Hayes
- Provider
- provider Mose Kertzmann
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
0194ec83-bb8c-3a71-8a5b-820bd2b2f9fa