Claim total
$113.75
base $93.39 · payer covered $63.75
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2020-04-07
- Stop
- 2020-04-07
The parties
- Patient
- patient Nicky Kristi Wiegand
- Provider
- provider Lady Frami
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
0358d022-e88b-b208-c53e-a753cb938bfb