Claim total
$2,074.03
base $93.83 · payer covered $1,974.03
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-03-08
- Stop
- 2010-03-08
The parties
- Patient
- patient Nestor Dannie Lockman
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
1320f2b9-2201-d6ed-2896-cdcabd52bcc8