Claim total
$533.77
base $93.39 · payer covered $483.77
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2016-09-07
- Stop
- 2016-09-07
The parties
- Patient
- patient Mandy Christie Stracke
- Provider
- provider Krystal Strosin
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00aca497-ef30-85f4-f935-300b31b60c5a