Claim total
$704.41
base $93.83 · payer covered $604.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-08-21
- Stop
- 2013-08-21
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-ef30-85f4-64fe-f649fb0039f7