Claim total
$498.76
base $93.83 · payer covered $348.76
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1999-12-07
- Stop
- 1999-12-07
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-91fd-e8391145385a