Claim total
$106.59
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2023-06-26
- Stop
- 2023-06-26
The parties
- Patient
- patient Onie Shannon Borer
- Provider
- provider Ines Kautzer
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Anthem
Record id
006af299-d813-2b4f-4ea1-934219d461be