Claim total
$1,794.72
base $93.83 · payer covered $1,694.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-08-24
- Stop
- 2016-08-24
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-b326-8f418f38617f