Claim total
$98.88
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2007-06-18
- Stop
- 2007-06-18
The parties
- Patient
- patient Chantay Victorina Koepp
- Provider
- provider Leonora Bechtelar
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
00c59201-9d52-fccb-f40c-d25b92481368