Claim total
$111.63
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2019-04-01
- Stop
- 2019-04-01
The parties
- Patient
- patient Leif Darren West
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
04bc601b-5b17-3710-0af8-b2b1af1b7201