Claim total
$152.04
base $93.39 · payer covered $102.04
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2021-04-20
- Stop
- 2021-04-20
The parties
- Patient
- patient Nicky Kristi Wiegand
- Provider
- provider Noreen Hudson
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
0358d022-e88b-b208-f8dd-bc6ded01711d