Claim total
$705.00
base $93.39 · payer covered $655.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1989-01-01
- Stop
- 1989-01-01
The parties
- Patient
- patient Jon Lavern Baumbach
- Provider
- provider Josh Stamm
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
033f4a7e-c2bc-1f12-b1f9-49d817472886