Claim total
$1,142.27
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-06-07
- Stop
- 2025-06-07
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Anthem
Record id
001727b6-dbde-2493-3105-b3f8e888760a