Claim total
$110.00
base $93.39 · payer covered $60.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-02-11
- Stop
- 2025-02-11
The parties
- Patient
- patient Cristobal Dana Wolf
- Provider
- provider Carmine Carter
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
016cc0d6-9a88-e8dc-849a-b1b01b435806