Claim total
$96.47
base $93.39 · payer covered $46.47
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2018-10-31
- Stop
- 2018-10-31
The parties
- Patient
- patient Cecilia Botsford
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
046c8377-6cc1-c8f9-16f7-3ab2c9a98232