Claim total
$94.73
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1986-10-31
- Stop
- 1986-10-31
The parties
- Patient
- patient Marilynn Jaimie Pouros
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
0126af27-a469-d3f6-2396-a8b2a9eea3c0