Claim total
$105.45
base $93.39 · payer covered $105.45
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2025-12-11
- Stop
- 2025-12-12
The parties
- Patient
- patient Temple Joe Beer
- Provider
- provider Rosina Schaden
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
031e9e86-1ff9-e433-5e2b-615c46a1d689