Claim total
$1,463.73
base $93.83 · payer covered $1,363.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-02-14
- Stop
- 2012-02-14
The parties
- Patient
- patient Cleo Timothy Kemmer
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
04d0e486-8d5f-7bad-9695-98a6b08578df