Claim total
$632.61
base $93.83 · payer covered $632.61
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-09-28
- Stop
- 2017-09-28
The parties
- Patient
- patient Salvador Hernán Marrero
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
003934f5-fa99-8d07-235c-1d1a5a00c3a5