Claim total
$586.17
base $93.39 · payer covered $468.20
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2008-07-11
- Stop
- 2008-07-11
The parties
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Anthem
Record id
02e77898-0a14-d00d-869f-4228508cab6f