Claim total
$427.79
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2016-12-17
- Stop
- 2016-12-17
The parties
- Patient
- patient Angele Khalilah Kuphal
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer No insurance
Record id
044947be-396f-8eb7-2fb0-d1723594f5db