Claim total
$846.78
base $93.83 · payer covered $846.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-08-16
- Stop
- 2017-08-16
The parties
- Patient
- patient Adam Alfonzo Stokes
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
056ed411-c295-a5c9-20c1-aa037cde50f1