Claim total
$836.12
base $93.83 · payer covered $686.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1986-08-29
- Stop
- 1986-08-29
The parties
- Patient
- patient Danielle Frami
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
0eed755f-204b-92be-c442-1911724c01da