Claim total
$135.77
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2018-11-26
- Stop
- 2018-11-26
The parties
- Patient
- patient Bo Gino Murazik
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
003af57f-1886-144b-379c-7d3b16b33c15