Claim total
$840.41
base $93.83 · payer covered $840.41
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-10-22
- Stop
- 2019-10-22
The parties
- Patient
- patient Mirta Nakisha Franecki
- Provider
- provider Benjamín Montoya
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
05902870-85f1-fda1-3b6b-90d206b23563