Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1979-08-03
- Stop
- 1979-08-03
The parties
- Patient
- patient Scott Emelina Fisher
- Provider
- provider Kathern Krajcik
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
3876b3a4-351a-6d35-f28e-95de0b65c22b