Claim total
$161.09
base $93.39 · payer covered $111.09
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2017-10-25
- Stop
- 2017-10-25
The parties
- Patient
- patient Cecilia Botsford
- Provider
- provider Verdie Schowalter
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
046c8377-6cc1-c8f9-a5a8-81555314b4b3