Claim total
$176.92
base $93.39 · payer covered $126.92
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2017-03-28
- Stop
- 2017-03-28
The parties
- Patient
- patient Cleo Timothy Kemmer
- Provider
- provider Morton Boyer
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
04d0e486-8d5f-7bad-b21a-b940a24179fd