Claim total
$293.11
base $93.83 · payer covered $193.11
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-10-10
- Stop
- 2019-10-10
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-fa99-8d07-4ea3-f0e9a23ee146