Claim total
$1,177.23
base $93.83 · payer covered $1,177.23
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-07-11
- Stop
- 2022-07-11
The parties
- Provider
- provider Benjamín Montoya
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
04481159-34f8-6925-abc7-9e5605946e19