Claim total
$773.81
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2018-11-26
- Stop
- 2018-11-26
The parties
- Patient
- patient Phylis Elenora Cassin
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Humana
Record id
0400c40b-e8b5-c779-453c-ccb1d2e367e7