Claim total
$169.07
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2011-06-26
- Stop
- 2011-06-26
The parties
- Patient
- patient Leo Ramon Wolf
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Cigna Health
Record id
0132d8d5-6e6e-d90f-260e-6a7370b22634