Claim total
$836.12
base $93.83 · payer covered $686.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-08-02
- Stop
- 2005-08-02
The parties
- Patient
- patient Lupe Heathcote
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
22929a68-92a8-362b-4ca6-a25466dd447c