Claim total
$110.69
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2016-03-13
- Stop
- 2016-03-13
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Georgetta Kohler
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-afc0-754465913ffb