Claim total
$1,130.91
base $93.83 · payer covered $1,130.91
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-10-28
- Stop
- 2019-10-28
The parties
- Patient
- patient Nana Earlean Kuphal
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
01077a3b-80bd-4b83-0a72-66ff0df3af31