Claim total
$639.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-10-04
- Stop
- 2025-10-04
The parties
- Patient
- patient Reatha Victor O'Conner
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Aetna
Record id
0521a0be-ba7b-b4e6-7102-e66d92e65330