Claim total
$1,054.85
base $93.83 · payer covered $1,054.85
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-05-09
- Stop
- 2025-05-09
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Joaquin Krajcik
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-09d3-82f4b0c85329