Claim total
$1,052.43
base $93.83 · payer covered $1,052.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-09-17
- Stop
- 2021-09-17
The parties
- Patient
- patient Dusty Tyson Heidenreich
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Dual Eligible
Record id
2cd4188f-31dd-c72f-7757-0a41097a7dfc