Claim total
$711.72
base $93.83 · payer covered $611.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-05-09
- Stop
- 2011-05-09
The parties
- Provider
- provider Benjamín Montoya
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
04481159-34f8-6925-107c-a0d3646d2f2d