Claim total
$206.95
base $93.39 · payer covered $156.95
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2005-10-30
- Stop
- 2005-10-30
The parties
- Patient
- patient Rex Jules Denesik
- Provider
- provider Walter Volkman
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
06303127-1d9c-5fa8-0bad-c25ca046b371