Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-11-03
- Stop
- 2004-11-03
The parties
- Patient
- patient Shawnee Lennie Baumbach
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer No insurance
Record id
0c7f9ef0-cfa4-6265-81f5-229a96053e6a