Claim total
$119.00
base $93.39 · payer covered $69.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2002-12-25
- Stop
- 2002-12-25
The parties
- Patient
- patient Soledad Rocio Aguirre
- Provider
- provider Alonso Hackett
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
060aa7a8-9653-5ae4-fe93-3e8f5f3f6ef5