Claim total
$777.13
base $93.83 · payer covered $777.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-02-16
- Stop
- 2014-02-16
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-5fa8-9f3e-2cec9e142b18