Claim total
$973.34
base $93.83 · payer covered $873.34
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-05-14
- Stop
- 2026-05-14
The parties
- Patient
- patient Johnny Mattie Skiles
- Provider
- provider Dirk D'Amore
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
01f72a06-0d81-377c-49fc-9a7beb32a17d