Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-05-15
- Stop
- 2025-05-15
The parties
- Patient
- patient Bettyann Wen Howell
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
0257a216-88a6-e7f3-fa20-05ae267109a0