Claim total
$120.87
base $93.39 · payer covered $120.87
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2019-09-09
- Stop
- 2019-09-09
The parties
- Patient
- patient Aubrey Mattie Turcotte
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Humana
Record id
01ad68d8-96ec-fcdf-90b6-31e98c681145