Claim total
$125.96
base $93.39 · payer covered $125.96
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2026-05-08
- Stop
- 2026-05-08
The parties
- Patient
- patient Queenie Van Keebler
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
046b1f1e-c36f-c080-b6b4-fbc42077e014