Claim total
$162.62
base $93.39 · payer covered $112.62
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2024-07-22
- Stop
- 2024-07-22
The parties
- Patient
- patient Coretta Philomena Boyle
- Provider
- provider Krystal Strosin
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
06293262-0c72-c029-eca8-c2211a6a8c17