Claim total
$1,109.72
base $93.83 · payer covered $1,009.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-05-09
- Stop
- 2024-05-09
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-80f7-2c7b51302d0d