Claim total
$157.18
base $93.39 · payer covered $157.18
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2008-08-24
- Stop
- 2008-08-24
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Garret Mohr
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-f8ae-8863fbbbaa82