Claim total
$1,043.93
base $93.83 · payer covered $893.93
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1964-04-21
- Stop
- 1964-04-21
The parties
- Patient
- patient Arvilla Cummings
- Provider
- provider Guillermo Granado
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
20950ce0-88d5-8d6a-112d-9c19db6a7293