Claim total
$104.68
base $93.39 · payer covered $54.68
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2017-11-15
- Stop
- 2017-11-15
The parties
- Patient
- patient Ronald Inga Torphy
- Provider
- provider Josh Stamm
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
05af61d0-e78c-a60a-5d50-a167dcc4852a