Claim total
$680.94
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1943-07-23
- Stop
- 1943-07-23
The parties
- Patient
- patient Raye Suzy Gusikowski
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
02c06e54-48b8-2b73-ce58-34db79957d24