Claim total
$105.61
base $93.39 · payer covered $55.61
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2002-09-04
- Stop
- 2002-09-05
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
03ef4f74-940b-d219-5f2f-d97f9e289ab4