Claim total
$203.64
base $93.39 · payer covered $153.64
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2018-12-18
- Stop
- 2018-12-18
The parties
- Patient
- patient Queen Sharika Fay
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
02c148c0-182c-a5fd-0af6-18813cbe57a3