Claim total
$846.78
base $93.83 · payer covered $696.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-08-11
- Stop
- 2004-08-11
The parties
- Patient
- patient Mandy Christie Stracke
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
00aca497-ef30-85f4-2195-109e3c266067