Claim total
$200.64
base $93.39 · payer covered $150.64
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2024-07-31
- Stop
- 2024-07-31
The parties
- Provider
- provider Edmond Bauch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00efc86d-40fa-9fdc-942f-2d0cbd5d06e5