Claim total
$979.43
base $93.83 · payer covered $879.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-01-31
- Stop
- 2014-01-31
The parties
- Patient
- patient Quintin Antonia Schmidt
- Provider
- provider Dirk D'Amore
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0d7376e6-0f47-a329-a761-1335419efe93