Claim total
$229.06
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2007-03-02
- Stop
- 2007-03-02
The parties
- Patient
- patient Loma Tawanna Ferry
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
04384da7-7311-e99a-7bc1-dc4195902595