Claim total
$119.32
base $93.39 · payer covered $95.45
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2024-07-28
- Stop
- 2024-07-28
The parties
- Patient
- patient Terrance Derek Mueller
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer UnitedHealthcare
Record id
032e5f12-51a3-9303-5525-e1b38c1c20b4