Claim total
$704.41
base $93.83 · payer covered $604.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-07-18
- Stop
- 2018-07-18
The parties
- Patient
- patient Kiana Howe
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer Medicaid
Record id
30d878c5-b0cb-d2f7-17d8-0ac4040bce10