Claim total
$976.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-06-13
- Stop
- 2026-06-13
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Anthem
Record id
001727b6-dbde-2493-7e43-fc00df9b9f0e