Claim total
$1,049.08
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1966-08-13
- Stop
- 1966-08-13
The parties
- Patient
- patient Carylon Erlinda Bergnaum
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer No insurance
Record id
0aff79a2-450d-907e-22eb-e4808b701055