Claim total
$108.33
base $93.39 · payer covered $58.33
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-05-25
- Stop
- 2021-05-25
The parties
- Patient
- patient An Wenona Rau
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
04682680-f77d-0a00-8e33-f19c7df0330e