Claim total
$1,114.99
base $93.83 · payer covered $964.99
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1971-03-21
- Stop
- 1971-03-21
The parties
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
0e6822a3-5e9a-9e56-cece-3d2ab2c5a08c