Claim total
$780.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1968-12-04
- Stop
- 1968-12-04
The parties
- Patient
- patient Shawnee Lennie Baumbach
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer No insurance
Record id
0c7f9ef0-cfa4-6265-f9ee-4a8ff34f8d87