Claim total
$1,083.42
base $93.83 · payer covered $933.42
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1984-04-22
- Stop
- 1984-04-22
The parties
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
0e6822a3-5e9a-9e56-efcf-13733877c823