Claim total
$1,005.89
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-02-29
- Stop
- 2016-02-29
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-5087-4274-d91e21a7c141