Claim total
$127.49
base $93.39 · payer covered $127.49
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2018-01-28
- Stop
- 2018-01-28
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Georgetta Kohler
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-ffae-1983668f82e0