Claim total
$133.24
base $93.39 · payer covered $83.24
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2019-12-24
- Stop
- 2019-12-24
The parties
- Patient
- patient Queen Sharika Fay
- Provider
- provider Garret Mohr
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
02c148c0-182c-a5fd-c493-dd29f5f77a20