Claim total
$160.40
base $93.39 · payer covered $110.40
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2018-03-24
- Stop
- 2018-03-24
The parties
- Patient
- patient Zachery Vincenzo Berge
- Provider
- provider Damien Mante
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
01ce818c-8f9f-924a-3056-cd37351f0123