Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-03-06
- Stop
- 2004-03-06
The parties
- Patient
- patient Heriberto Orval Feest
- Provider
- provider Dirk D'Amore
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer UnitedHealthcare
Record id
04dd6dd9-2faa-05da-c3f0-2209c27a06d3