Claim total
$1,221.49
base $93.83 · payer covered $1,171.49
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1941-11-11
- Stop
- 1941-11-11
The parties
- Patient
- patient Lucie Shayla Metz
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
0095f26f-6c35-6a9c-29d8-a6bda0328a66