Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-08-25
- Stop
- 2011-08-25
The parties
- Patient
- patient Garry Jarvis Mosciski
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Anthem
Record id
30b16a0b-bea1-7e53-8393-32b472fe8b72