Claim total
$772.84
base $93.83 · payer covered $622.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-03-24
- Stop
- 2003-03-24
The parties
- Provider
- provider Benjamín Montoya
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
04481159-34f8-6925-9dae-38236d950cef