Claim total
$1,087.23
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1974-06-05
- Stop
- 1974-06-05
The parties
- Patient
- patient Mitsue Sipes
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer No insurance
Record id
12bc3113-50d7-c8ca-5453-3672989c5fee