Claim total
$109.92
base $93.39 · payer covered $59.92
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 1977-12-17
- Stop
- 1977-12-17
The parties
- Patient
- patient Elbert Rod Lemke
- Provider
- provider Josh Stamm
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
039e51d1-c563-811d-ce58-179fd06d1841