Claim total
$973.34
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-12-29
- Stop
- 2009-12-29
The parties
- Patient
- patient Leandro Lloyd Ratke
- Provider
- provider Brianne Erdman
- Care site
- care site DAKOTA MEDICAL CLINIC, PA
- Payer
- payer No insurance
Record id
322d2eb8-0c80-96f1-8a9e-1cd868afd695