Claim total
$1,314.72
base $93.83 · payer covered $1,314.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-09-02
- Stop
- 2020-09-02
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-c590-3ea3f7c5bd70