Claim total
$1,457.08
base $93.83 · payer covered $1,457.08
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-08-15
- Stop
- 2012-08-15
The parties
- Patient
- patient Boyce Grover Weissnat
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
39e894b0-0ad4-ea59-6179-111ca9e80ba9