Claim total
$94.08
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-09-25
- Stop
- 2021-09-25
The parties
- Patient
- patient Reatha Victor O'Conner
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Aetna
Record id
0521a0be-ba7b-b4e6-581e-8903ae00693e