Claim total
$979.43
base $93.83 · payer covered $879.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-08-17
- Stop
- 2010-08-17
The parties
- Patient
- patient Branden Milford Ullrich
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
10ef12fb-14dc-88af-3cf9-c11b6b1bb1bf