Claim total
$106.08
base $93.39 · payer covered $56.08
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1974-05-23
- Stop
- 1974-05-23
The parties
- Patient
- patient Cathryn Kandy Smith
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
038ad96a-9908-2f0d-da94-82c5e4c156f3