Claim total
$979.48
base $93.83 · payer covered $979.48
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-08-16
- Stop
- 2018-08-16
The parties
- Patient
- patient Ferdinand Kasey Ernser
- Provider
- provider Jan Nicolas
- Payer
- payer Medicaid
Record id
062e401f-723c-d87d-99ab-b340d1791a72