Claim total
$772.84
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1995-01-22
- Stop
- 1995-01-22
The parties
- Patient
- patient Ellis Ava Walter
- Provider
- provider Dustin Ernser
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer No insurance
Record id
3aaf63ad-d263-2868-b73c-eaa47fb0c897