Claim total
$641.13
base $93.83 · payer covered $634.96
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-12-28
- Stop
- 2025-12-28
The parties
- Patient
- patient Eleonora Elfriede Johns
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
059d8239-ee62-6881-785b-b33dcfb40a02