Claim total
$838.28
base $93.83 · payer covered $838.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-06-23
- Stop
- 2025-06-23
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-944d-c53c0f8db150