Claim total
$138.20
base $93.39 · payer covered $88.20
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2017-07-16
- Stop
- 2017-07-16
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-c11b-269363cf8edb