Claim total
$128.80
base $93.39 · payer covered $77.28
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2023-11-30
- Stop
- 2023-12-01
The parties
- Patient
- patient Temple Joe Beer
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
031e9e86-1ff9-e433-e5ba-28d5e7b5fc0e