Claim total
$1,041.44
base $93.83 · payer covered $941.44
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-07-05
- Stop
- 2022-07-05
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-275c-5b2193c3dbbc