Claim total
$653.42
base $93.39 · payer covered $603.42
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-05-22
- Stop
- 2025-05-22
The parties
- Patient
- patient Bettyann Wen Howell
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
0257a216-88a6-e7f3-0920-de2c2d27ebb7