Claim total
$114.33
base $93.39 · payer covered $64.33
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2017-06-11
- Stop
- 2017-06-11
The parties
- Patient
- patient Terrance Raymon Kuhic
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
03e733d5-721a-3740-eeb2-8bbabd45c2c1