Claim total
$773.83
base $93.83 · payer covered $773.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-04-22
- Stop
- 2025-04-22
The parties
- Patient
- patient Kendrick Jewell Jerde
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
020a56e3-5d79-5c72-c991-489966daae28