Claim total
$173.98
base $93.39 · payer covered $123.98
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2024-12-03
- Stop
- 2024-12-03
The parties
- Patient
- patient Evangeline Kasha Schaden
- Provider
- provider Josh Stamm
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
0632026e-bab4-0d77-b7d3-b5d807e8e85a