Claim total
$364.10
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2024-03-14
- Stop
- 2024-03-14
The parties
- Patient
- patient Allen Trent Mann
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Humana
Record id
007bcc47-8ca5-7eab-25e7-3dd25cc056c4