Claim total
$255.96
base $93.39 · payer covered $205.96
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2008-06-01
- Stop
- 2008-06-01
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-4f41-e333d6360e90