Claim total
$1,423.18
base $93.39 · payer covered $1,373.18
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 1962-02-12
- Stop
- 1962-02-12
The parties
- Patient
- patient Chung Spinka
- Provider
- provider Carmine Carter
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
0453bbfc-4b53-3293-29dd-fad8123cd0b0