Claim total
$113.22
base $93.39 · payer covered $63.22
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2024-08-25
- Stop
- 2024-08-25
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Darnell Reynolds
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-24f5-c067389058c3