Claim total
$843.43
base $93.83 · payer covered $843.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-10-21
- Stop
- 2013-10-21
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-4b83-7e34-551ac067a305