Claim total
$188.31
base $93.39 · payer covered $138.31
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2018-01-27
- Stop
- 2018-01-27
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Mario Wilkinson
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-97bd-a53bc9601929