Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1961-04-18
- Stop
- 1961-04-18
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-8e11-c76af5923eac