Claim total
$846.78
base $93.83 · payer covered $696.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-10-06
- Stop
- 2003-10-06
The parties
- Patient
- patient Nana Earlean Kuphal
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
01077a3b-80bd-4b83-2a46-a6b3d01b3067