Claim total
$843.43
base $93.83 · payer covered $743.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-08-30
- Stop
- 2025-08-30
The parties
- Patient
- patient Logan Stefan Crist
- Provider
- provider Dirk D'Amore
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0bdc26bf-b2ef-ea95-1add-437d926c4f11