Claim total
$982.78
base $93.83 · payer covered $982.78
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-11-13
- Stop
- 2025-11-13
The parties
- Patient
- patient Salvador Hernán Marrero
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
003934f5-fa99-8d07-386a-f8b29d980b30