Claim total
$1,292.75
base $93.83 · payer covered $1,292.75
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-03-12
- Stop
- 2021-03-12
The parties
- Patient
- patient Rosalind Gertude Olson
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Dual Eligible
Record id
30209f9b-1d78-f7a0-fb52-69ddd15120ba