Claim total
$105.18
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-12-30
- Stop
- 2025-12-30
The parties
- Patient
- patient Jared Lenard Hansen
- Provider
- provider Jong King
- Care site
- care site MERCY HOSPITAL
- Payer
- payer Aetna
Record id
047ee4ec-c50b-b504-d611-d3e8ec249cbc