Claim total
$271.45
base $93.39 · payer covered $221.45
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2015-08-19
- Stop
- 2015-08-19
The parties
- Patient
- patient Adam Alfonzo Stokes
- Provider
- provider Leonora Bechtelar
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
056ed411-c295-a5c9-9de5-3b8b0ea0902c