Claim total
$1,542.90
base $93.83 · payer covered $1,442.90
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-08-10
- Stop
- 2025-08-10
The parties
- Provider
- provider Benjamín Montoya
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
15cb802f-0b72-34e6-5752-e5a9651fb97b