Claim total
$910.06
base $93.83 · payer covered $760.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-12-16
- Stop
- 2005-12-16
The parties
- Patient
- patient Rosalind Gertude Olson
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
30209f9b-1d78-f7a0-b6dc-4ed6a5d50552