Claim total
$290.38
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2022-04-18
- Stop
- 2022-04-18
The parties
- Patient
- patient Leif Darren West
- Provider
- provider Mario Wilkinson
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
04bc601b-5b17-3710-7c27-9b6f66ca519e