Claim total
$772.84
base $93.83 · payer covered $622.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1980-04-19
- Stop
- 1980-04-19
The parties
- Patient
- patient Ray Wallace Langworth
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
2485aef5-15a8-d55e-83d9-ccd0e1cb4b12