Claim total
$107.75
base $93.39 · payer covered $57.75
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1980-01-30
- Stop
- 1980-01-30
The parties
- Patient
- patient Soledad Rocio Aguirre
- Provider
- provider Wan Osinski
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
060aa7a8-9653-5ae4-e06e-52b48b855824