Claim total
$843.43
base $93.83 · payer covered $743.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-09-04
- Stop
- 2023-09-04
The parties
- Patient
- patient Jo Bettyann Durgan
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
09f0f2d1-be2b-4994-07e5-3deac5ccc8f7