Claim total
$275.08
base $93.39 · payer covered $225.08
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1997-03-05
- Stop
- 1997-03-05
The parties
- Patient
- patient Soledad Rocio Aguirre
- Provider
- provider Alonso Hackett
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
060aa7a8-9653-5ae4-e73c-5260c9f9a31b