Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-06-22
- Stop
- 2019-06-22
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Anthem
Record id
001727b6-dbde-2493-1187-98fc6047de96