Claim total
$4,603.12
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1975-08-23
- Stop
- 1975-08-23
The parties
- Patient
- patient Carylon Erlinda Bergnaum
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer No insurance
Record id
0aff79a2-450d-907e-49c8-d04322b18c9f