Claim total
$204.21
base $93.39 · payer covered $154.21
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2024-04-17
- Stop
- 2024-04-17
The parties
- Provider
- provider Josh Stamm
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
010d736c-d81f-3cd7-bccb-fbbafaa2128d