Claim total
$220.85
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2001-06-24
- Stop
- 2001-06-25
The parties
- Patient
- patient Mike Brendon Hackett
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
048bde62-95d9-bb18-2699-36bc8544f807