Claim total
$775.00
base $93.83 · payer covered $625.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-07-04
- Stop
- 1997-07-04
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-fc75-a86d768ceee4