Claim total
$1,212.40
base $93.83 · payer covered $1,062.40
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1992-12-06
- Stop
- 1992-12-06
The parties
- Patient
- patient Gilbert Ivan Bauch
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
0c35b5fe-1f15-f1f3-5f57-13e94b7ab301