Claim total
$172.54
base $93.39 · payer covered $103.52
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2023-04-21
- Stop
- 2023-04-21
The parties
- Patient
- patient Agnus Jaskolski
- Provider
- provider Josh Stamm
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Humana
Record id
00bd0ed6-396a-5390-6e62-7a52bcd3cf9a