Claim total
$910.06
base $93.83 · payer covered $910.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-07-06
- Stop
- 2017-07-06
The parties
- Patient
- patient Johnny Mattie Skiles
- Provider
- provider Efren Sporer
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
01f72a06-0d81-377c-3042-841fffba3861