Claim total
$453.80
base $93.39 · payer covered $403.80
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2017-10-27
- Stop
- 2017-10-27
The parties
- Patient
- patient Danial Hal Lang
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
06067a48-9015-34d7-8490-31ae4b1097c9