Claim total
$103.65
base $93.39 · payer covered $53.65
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2019-05-18
- Stop
- 2019-05-18
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-da75-40cf-7c19d1d37169