Claim total
$178.28
base $93.39 · payer covered $128.28
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2020-12-12
- Stop
- 2020-12-12
The parties
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-b5e0-7aaa7684ab68