Claim total
$205.51
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2017-07-21
- Stop
- 2017-07-21
The parties
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Cigna Health
Record id
02e77898-0a14-d00d-fa58-0aeee1cb9f6d