Claim total
$1,362.72
base $93.83 · payer covered $1,262.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-09-03
- Stop
- 2024-09-03
The parties
- Patient
- patient Stevie Gorczany
- Provider
- provider Efren Sporer
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
1cb87270-7b3e-ee91-5da8-23d214098e87