Claim total
$136.86
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2013-07-07
- Stop
- 2013-07-07
The parties
- Patient
- patient Leo Ramon Wolf
- Provider
- provider Edmond Bauch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Cigna Health
Record id
0132d8d5-6e6e-d90f-6088-e530a72f7113