Claim total
$1,116.65
base $93.83 · payer covered $1,116.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-06-13
- Stop
- 2026-06-13
The parties
- Patient
- patient Ray Wallace Langworth
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Dual Eligible
Record id
2485aef5-15a8-d55e-c018-d4f1192a27ea