Claim total
$1,047.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-03-15
- Stop
- 2026-03-15
The parties
- Patient
- patient Jolyn Lizette Keeling
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer No insurance
Record id
28d785bf-7b54-eb32-04ca-a9198cb0969e