Claim total
$781.37
base $93.83 · payer covered $781.37
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-08-07
- Stop
- 2013-08-07
The parties
- Patient
- patient Bill Antonio Gleason
- Provider
- provider Dirk D'Amore
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
29eef510-cf92-084f-d3d6-829e0033866b