Claim total
$125.96
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2021-09-07
- Stop
- 2021-09-07
The parties
- Patient
- patient Janie Ranae Botsford
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer No insurance
Record id
041efb3a-8e81-3ea8-97fb-2635624a7294