Claim total
$119.63
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2025-02-12
- Stop
- 2025-02-12
The parties
- Patient
- patient Nichol Clara Predovic
- Provider
- provider Alesia Douglas
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
0130f9d2-4df9-4b02-6215-12ed681c5a97