Claim total
$787.46
base $93.83 · payer covered $423.25
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-09-05
- Stop
- 2006-09-05
The parties
- Patient
- patient Jonie Beckie Crooks
- Provider
- provider Benjamín Montoya
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer UnitedHealthcare
Record id
2ff943bc-7162-f8cc-5d2b-bb7a328eabb9