Claim total
$143.94
base $93.39 · payer covered $93.94
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2025-12-16
- Stop
- 2025-12-16
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-e60d-4765f207abbe