Claim total
$110.85
base $93.39 · payer covered $60.85
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1974-09-25
- Stop
- 1974-09-25
The parties
- Patient
- patient Joe Maximo Kozey
- Provider
- provider Jong King
- Care site
- care site MERCY HOSPITAL
- Payer
- payer Medicaid
Record id
0135e6bd-cd4d-6318-5b3c-0c3aa1db201e