Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-04-12
- Stop
- 2022-04-12
The parties
- Patient
- patient Cleo Timothy Kemmer
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
04d0e486-8d5f-7bad-66bb-135007d50013