Claim total
$999.21
base $93.83 · payer covered $899.21
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2007-07-29
- Stop
- 2007-07-29
The parties
- Patient
- patient Carmen Omer Mayer
- Provider
- provider Efren Sporer
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
36c86f70-85b0-1d4b-028f-04873c7820d6