Claim total
$1,142.05
base $93.83 · payer covered $992.05
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1993-07-31
- Stop
- 1993-07-31
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
001727b6-dbde-2493-8d55-9f14f3b9fa23