Claim total
$853.86
base $93.83 · payer covered $753.86
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-10-18
- Stop
- 2010-10-18
The parties
- Patient
- patient Nana Earlean Kuphal
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
01077a3b-80bd-4b83-7da6-a442505a5cc9