Claim total
$711.72
base $93.83 · payer covered $711.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-05-14
- Stop
- 2018-05-14
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-8883-754e3d730411