Claim total
$178.79
base $93.39 · payer covered $128.79
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- procedure concept Patient referral for dental care103697008
- Start
- 2019-10-30
- Stop
- 2019-10-30
The parties
- Patient
- patient Amanda Rheba Mitchell
- Provider
- provider Damien Mante
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
0363ed75-83f4-7675-01e9-479e0a3f1a32