Claim total
$115.79
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1988-08-12
- Stop
- 1988-08-12
The parties
- Patient
- patient Raye Suzy Gusikowski
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
02c06e54-48b8-2b73-52ee-ca181c7819c8