Claim total
$847.72
base $93.83 · payer covered $847.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-08-19
- Stop
- 2006-08-19
The parties
- Patient
- patient Dora Violet Okuneva
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
001727b6-dbde-2493-b325-8fe768c024d9