Claim total
$780.15
base $93.83 · payer covered $730.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1990-06-05
- Stop
- 1990-06-05
The parties
- Patient
- patient Dione Anissa Jaskolski
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
24b7c6b0-4eef-ea68-e322-8a4b14391e34