Claim total
$129.89
base $93.39 · payer covered $103.91
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2016-11-08
- Stop
- 2016-11-08
The parties
- Patient
- patient Jared Lenard Hansen
- Provider
- provider Jong King
- Care site
- care site MERCY HOSPITAL
- Payer
- payer Anthem
Record id
047ee4ec-c50b-b504-b9db-b09470af2a48