Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-08-06
- Stop
- 2003-08-06
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-ef30-85f4-9a47-11f136fcb2c2