Claim total
$116.18
base $93.39 · payer covered $66.18
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1999-01-16
- Stop
- 1999-01-16
The parties
- Provider
- provider Clyde Beier
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-dc6b-65592fbbcb6e