Claim total
$916.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-03-18
- Stop
- 2019-03-18
The parties
- Patient
- patient Leroy Javier Batz
- Provider
- provider Dustin Ernser
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer Humana
Record id
2c19b131-403a-5087-369f-d97d910a49c8