Claim total
$1,527.01
base $93.83 · payer covered $56.76
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1967-11-14
- Stop
- 1967-11-14
The parties
- Patient
- patient Pete Ignacio Feest
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer UnitedHealthcare
Record id
09b9c891-0bef-2077-3a3a-c8bf5d95506f