Claim total
$1,189.48
base $93.83 · payer covered $1,189.48
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2023-11-23
- Stop
- 2023-11-23
The parties
- Patient
- patient Ferdinand Kasey Ernser
- Provider
- provider Jan Nicolas
- Payer
- payer Dual Eligible
Record id
062e401f-723c-d87d-2f67-9a61b3510666