Claim total
$180.78
base $93.39 · payer covered $180.78
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2017-12-27
- Stop
- 2017-12-27
The parties
- Patient
- patient Nichol Clara Predovic
- Provider
- provider Julia Dueñas
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
0130f9d2-4df9-4b02-f74f-afa9119c2a17