Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1999-05-05
- Stop
- 1999-05-05
The parties
- Patient
- patient Carolee Shenna Franecki
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer No insurance
Record id
05da998f-3dd0-aeca-dd3a-4af30b6780b1