Claim total
$114.87
base $93.39 · payer covered $64.87
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1970-01-23
- Stop
- 1970-01-23
The parties
- Patient
- patient Ronnie Ina Gusikowski
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
003b30a0-7fd2-f42c-e85e-9b5c58ed3d23