Claim total
$139.04
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-01-15
- Stop
- 2025-01-15
The parties
- Patient
- patient Johnathon Enrique Herzog
- Provider
- provider Jong King
- Care site
- care site MERCY HOSPITAL
- Payer
- payer No insurance
Record id
01f4bd01-9c32-7236-fa27-113fa2be651c