Claim total
$163.37
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2018-10-30
- Stop
- 2018-10-31
The parties
- Patient
- patient Blake Rudolph Von
- Provider
- provider Carmine Carter
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Aetna
Record id
01986319-54e6-598a-2f33-60882a698808