Claim total
$164.51
base $93.39 · payer covered $114.51
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2021-02-13
- Stop
- 2021-02-13
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Damien Mante
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-2097-75812fd8fcfb