Claim total
$151.10
base $93.39 · payer covered $101.10
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2016-07-10
- Stop
- 2016-07-10
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-90a3-485c2b24058a