Claim total
$97.58
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2019-11-05
- Stop
- 2019-11-05
The parties
- Patient
- patient Blake Rudolph Von
- Provider
- provider Carmine Carter
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Aetna
Record id
01986319-54e6-598a-2055-0b79092061f2