Claim total
$103.84
base $93.39 · payer covered $53.84
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2023-08-20
- Stop
- 2023-08-20
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-5aa7-537b444bc240