Claim total
$103.60
base $93.39 · payer covered $103.60
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2007-02-04
- Stop
- 2007-02-04
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-3468-81fdf6b72ef3