Claim total
$711.72
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-07-01
- Stop
- 2023-07-01
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Anthem
Record id
001727b6-dbde-2493-c368-db443b68ae7c