Claim total
$973.34
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2001-11-14
- Stop
- 2001-11-14
The parties
- Patient
- patient Lamonica Candida Mante
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Humana
Record id
29980f80-2c14-58bc-29ff-6ead058b62e0