Claim total
$910.06
base $93.83 · payer covered $910.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-05-08
- Stop
- 2017-05-08
The parties
- Patient
- patient María del Carmen Berríos
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Dual Eligible
Record id
016a1a5e-4450-7aaa-aa1b-c0ea4eac88fb