Claim total
$289.34
base $93.39 · payer covered $239.34
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2023-01-27
- Stop
- 2023-01-27
The parties
- Patient
- patient Danial Hal Lang
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
06067a48-9015-34d7-5426-38a2d6b694c1