Claim total
$254.96
base $93.39 · payer covered $254.96
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2020-06-21
- Stop
- 2020-06-21
The parties
- Patient
- patient Xuan Collier
- Provider
- provider Morton Boyer
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
002d4429-df26-5797-2866-ed4ecd022d71