Claim total
$1,096.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1977-06-08
- Stop
- 1977-06-08
The parties
- Patient
- patient Mitsue Sipes
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer No insurance
Record id
12bc3113-50d7-c8ca-850d-7484208cb6bc