Claim total
$320.27
base $93.39 · payer covered $192.16
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2013-10-28
- Stop
- 2013-10-28
The parties
- Patient
- patient Augustus Rich Stark
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
0239a00d-0894-874c-b9d5-2211ed0431be