Claim total
$449.92
base $93.39 · payer covered $399.92
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2020-04-28
- Stop
- 2020-04-28
The parties
- Patient
- patient Sherill Ingeborg Wyman
- Provider
- provider Miyoko Botsford
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
03eccc4c-a1c4-14ad-992e-281e80e50189