Claim total
$840.41
base $93.83 · payer covered $740.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-04-30
- Stop
- 2020-04-30
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-23c6-795601309115