Claim total
$5,038.15
base $155.66 · payer covered $4,988.15
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2025-08-19
- Stop
- 2025-08-19
The parties
- Patient
- patient Royce Peter Wolf
- Provider
- provider Damien Mante
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
04658673-6112-6940-59c5-bf4c00efe783