Claim total
$134.89
base $93.39 · payer covered $84.89
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2017-10-24
- Stop
- 2017-10-24
The parties
- Patient
- patient Mirta Nakisha Franecki
- Provider
- provider Amber Yost
- Payer
- payer Medicaid
Record id
05902870-85f1-fda1-899b-80915d0fc18d