Claim total
$238.76
base $93.39 · payer covered $88.76
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1975-05-29
- Stop
- 1975-05-29
The parties
- Patient
- patient Cathryn Kandy Smith
- Provider
- provider Avery VonRueden
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
038ad96a-9908-2f0d-b241-cc17d2a237d2