Claim total
$203.54
base $93.39 · payer covered $153.54
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2022-04-26
- Stop
- 2022-04-26
The parties
- Patient
- patient Cleo Timothy Kemmer
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
04d0e486-8d5f-7bad-5d99-34d4c4be995c