Claim total
$777.13
base $93.83 · payer covered $777.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-11-25
- Stop
- 2025-11-25
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-a0f9-4bdcd39594ff