Claim total
$1,041.77
base $93.83 · payer covered $891.77
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1992-06-07
- Stop
- 1992-06-07
The parties
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
0e6822a3-5e9a-9e56-8718-27c2e0aceb12