Claim total
$210.75
base $93.39 · payer covered $160.75
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-07-01
- Stop
- 2021-07-01
The parties
- Patient
- patient Cathryn Kandy Smith
- Provider
- provider Avery VonRueden
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
038ad96a-9908-2f0d-5118-fd151046f954