Claim total
$1,289.94
base $93.83 · payer covered $1,139.94
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2000-06-26
- Stop
- 2000-06-26
The parties
- Patient
- patient María del Carmen Berríos
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
016a1a5e-4450-7aaa-3606-d1d3d43a345d