Claim total
$1,257.12
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-06-17
- Stop
- 2017-06-17
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Cigna Health
Record id
001727b6-dbde-2493-6b3f-51f98b7696e9