Claim total
$838.28
base $93.83 · payer covered $838.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-07-28
- Stop
- 2025-07-28
The parties
- Provider
- provider Benjamín Montoya
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
04481159-34f8-6925-be71-bf6f38fd7495