Claim total
$767.69
base $93.83 · payer covered $667.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-02-25
- Stop
- 2011-02-25
The parties
- Patient
- patient Justin Hai Altenwerth
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
0eb7ef7b-4862-efa5-3fd3-01776ba44cf5