Claim total
$140.63
base $93.39 · payer covered $90.63
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2013-10-29
- Stop
- 2013-10-29
The parties
- Patient
- patient Matt Stanton Brown
- Provider
- provider Sonny Mertz
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
04e52287-fbd6-ff57-2a0d-1bd4093b9d7f