Claim total
$846.78
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-12-02
- Stop
- 2015-12-02
The parties
- Patient
- patient Jeramy Diego Keebler
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Humana
Record id
024ea619-fff0-c0e8-7d60-9da23e6422fc