Claim total
$167.60
base $93.39 · payer covered $117.60
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2021-10-19
- Stop
- 2021-10-19
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Charlie Tillman
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-647c-e349ad2527ae