Claim total
$98.14
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2016-10-21
- Stop
- 2016-10-21
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-e178-f37c9cb1eba1