Claim total
$304.70
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1983-07-15
- Stop
- 1983-07-15
The parties
- Patient
- patient Raye Suzy Gusikowski
- Provider
- provider Verdie Schowalter
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
02c06e54-48b8-2b73-8a29-ee14228d832d