Claim total
$104.90
base $93.39 · payer covered $54.90
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-05-04
- Stop
- 2025-05-04
The parties
- Patient
- patient Rex Jules Denesik
- Provider
- provider Darnell Reynolds
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
06303127-1d9c-5fa8-27cd-48ab85dfad22