Claim total
$846.78
base $93.83 · payer covered $846.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-04-20
- Stop
- 2025-04-20
The parties
- Patient
- patient Rex Jules Denesik
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
06303127-1d9c-5fa8-7a94-fc9b847d285b