Claim total
$4,176.98
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-01-05
- Stop
- 2018-01-05
The parties
- Patient
- patient Norbert Mitch Rolfson
- Provider
- provider Dustin Ernser
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer Aetna
Record id
0e9a274f-7ba6-2bd1-97f0-e1633bcbaf1a