Claim total
$1,115.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-08-03
- Stop
- 2014-08-03
The parties
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Anthem
Record id
21fad517-d93d-a5ae-b2f2-bfd78dc54ede