Claim total
$170.88
base $93.39 · payer covered $120.88
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2024-10-12
- Stop
- 2024-10-12
The parties
- Patient
- patient Belva Nadene Kuphal
- Provider
- provider Josh Stamm
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
0430ce7c-cb64-da75-1c86-67055653f968