Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-09-14
- Stop
- 2022-09-14
The parties
- Patient
- patient Adam Alfonzo Stokes
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
056ed411-c295-a5c9-0a66-4f3c25e7749d