Claim total
$170.54
base $93.39 · payer covered $170.54
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2014-12-21
- Stop
- 2014-12-21
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-bf9e-c747e12f7100