Claim total
$6,029.28
base $155.66 · payer covered $5,979.28
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2017-04-22
- Stop
- 2017-04-22
The parties
- Patient
- patient Cecilia Botsford
- Provider
- provider Damien Mante
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
046c8377-6cc1-c8f9-07df-bd743aefb952