Claim total
$210.29
base $93.39 · payer covered $160.29
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2026-05-19
- Stop
- 2026-05-19
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-715a-017a16de5ff9