Claim total
$155.47
base $93.39 · payer covered $105.47
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2022-04-26
- Stop
- 2022-04-26
The parties
- Patient
- patient Nicky Kristi Wiegand
- Provider
- provider Silvana Weber
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
0358d022-e88b-b208-f172-629ec774c40a