Claim total
$161.29
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2020-04-11
- Stop
- 2020-04-11
The parties
- Patient
- patient Jeremy Gregory Jacobson
- Provider
- provider Charlie Tillman
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
Record id
04f9baea-0c64-12b2-9cbd-ba4d0535b6d0