Claim total
$1,116.65
base $93.83 · payer covered $1,016.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-06-18
- Stop
- 2025-06-18
The parties
- Patient
- patient Mandy Christie Stracke
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
00aca497-ef30-85f4-2431-e2a2ed9f3f56