Claim total
$1,255.18
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1996-04-19
- Stop
- 1996-04-19
The parties
- Patient
- patient Norbert Mitch Rolfson
- Provider
- provider Dustin Ernser
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer No insurance
Record id
0e9a274f-7ba6-2bd1-322e-adbd371e8772