Claim total
$154.89
base $93.39 · payer covered $108.42
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2018-12-28
- Stop
- 2018-12-28
The parties
- Patient
- patient Josh Monahan
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Cigna Health
Record id
03f57d95-a536-8def-3f58-33cdeae84043