Claim total
$838.28
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2008-04-01
- Stop
- 2008-04-01
The parties
- Patient
- patient Eliz Gwendolyn Gulgowski
- Provider
- provider Dirk D'Amore
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
1d6daf34-91f6-0901-413d-b0baeddb203c