Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-12-05
- Stop
- 2023-12-05
The parties
- Patient
- patient Corey Sherwood Larkin
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Aetna
Record id
23c57423-286f-e157-8dee-4ebc5fc6a772