Claim total
$110.99
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2014-03-07
- Stop
- 2014-03-07
The parties
- Patient
- patient Queenie Van Keebler
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
046b1f1e-c36f-c080-e2d5-5f7e6de0b519