Claim total
$112.82
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2022-01-13
- Stop
- 2022-01-13
The parties
- Patient
- patient Kaycee Luanne Mohr
- Provider
- provider Rosina Schaden
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer No insurance
Record id
03ac889d-2da8-a492-c240-f5f666aa2c7a