Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-10-10
- Stop
- 2017-10-10
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-a7c6-b64dbbdb400a