Claim total
$913.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-07-15
- Stop
- 2014-07-15
The parties
- Patient
- patient Eulah Avril Aufderhar
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer No insurance
Record id
02aef5a1-9ba3-229b-0c8c-52d2c4047f98