Claim total
$1,049.08
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-08-16
- Stop
- 2003-08-16
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer No insurance
Record id
001727b6-dbde-2493-eb89-e5a868cb20c7