Claim total
$985.80
base $93.83 · payer covered $985.80
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-04-09
- Stop
- 2011-04-09
The parties
- Patient
- patient Deidra Estell Ratke
- Provider
- provider Nicky Veum
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer Humana
Record id
24c555cb-8a8b-be81-b160-a8618f5a7144