Claim total
$710.78
base $93.83 · payer covered $560.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1990-08-28
- Stop
- 1990-08-28
The parties
- Patient
- patient Eulah Avril Aufderhar
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
02aef5a1-9ba3-229b-101b-54fb53c6ef10