Claim total
$773.83
base $93.83 · payer covered $773.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-05-17
- Stop
- 2018-05-17
The parties
- Patient
- patient Ferdinand Kasey Ernser
- Provider
- provider Jan Nicolas
- Payer
- payer Medicaid
Record id
062e401f-723c-d87d-de43-0b75e3ef9f42