Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-08-25
- Stop
- 2012-08-25
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Aetna
Record id
001727b6-dbde-2493-addf-61d2bf9649e3