Claim total
$1,112.41
base $93.83 · payer covered $1,112.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-08-28
- Stop
- 2019-08-28
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-add0-07e3be59aa41