Claim total
$1,217.28
base $93.83 · payer covered $1,067.28
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1985-10-12
- Stop
- 1985-10-12
The parties
- Patient
- patient Reatha Victor O'Conner
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
0521a0be-ba7b-b4e6-448e-fad16c4e7409