Claim total
$101.17
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2017-11-12
- Stop
- 2017-11-12
The parties
- Patient
- patient Margo Green
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
029fe5e1-f60c-f237-7d34-89e4c91e7dda