Claim total
$840.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-07-10
- Stop
- 2012-07-10
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-8445-bb8bc54248d7