Claim total
$780.15
base $93.83 · payer covered $680.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-06-22
- Stop
- 2019-06-22
The parties
- Patient
- patient Dane Thompson
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
15ff9697-8505-7f55-ea66-70f08392a2a8