Claim total
$1,597.60
base $93.83 · payer covered $1,597.60
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-02-16
- Stop
- 2016-02-16
The parties
- Patient
- patient Arvilla Cummings
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Dual Eligible
Record id
20950ce0-88d5-8d6a-5731-e4ec0a7279ae