Claim total
$777.13
base $93.83 · payer covered $768.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-02-25
- Stop
- 2014-02-25
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-bca2-fd3695813463