Claim total
$162.51
base $93.39 · payer covered $112.51
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2018-02-06
- Stop
- 2018-02-06
The parties
- Patient
- patient Elinore Danyelle Streich
- Provider
- provider Alonso Hackett
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
03b3068a-a726-461a-cdc3-cd7b8e9b2f2a