Claim total
$1,483.25
base $93.83 · payer covered $1,483.25
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-12-14
- Stop
- 2025-12-14
The parties
- Patient
- patient Wendie Kellie Reynolds
- Provider
- provider Dirk D'Amore
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
2d63fa27-766d-775f-17a6-61274434d2a8