Claim total
$1,404.22
base $93.83 · payer covered $1,404.22
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-03-15
- Stop
- 2018-03-15
The parties
- Patient
- patient Ferdinand Kasey Ernser
- Provider
- provider Jan Nicolas
- Payer
- payer Medicaid
Record id
062e401f-723c-d87d-dcb2-5273eec2475c