Claim total
$1,115.43
base $93.83 · payer covered $1,015.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-12-14
- Stop
- 2022-12-14
The parties
- Patient
- patient Kera Fritsch
- Provider
- provider Dirk D'Amore
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
323fd4e3-b776-d805-98e5-8e004ec046ed