Claim total
$391.01
base $93.39 · payer covered $341.01
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2018-04-08
- Stop
- 2018-04-08
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-1125-9a3a5f2d79f6