Claim total
$126.89
base $93.39 · payer covered $76.89
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2017-03-21
- Stop
- 2017-03-21
The parties
- Patient
- patient An Wenona Rau
- Provider
- provider Boris Lynch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
04682680-f77d-0a00-7d5f-ce961ccab269