Claim total
$843.43
base $93.83 · payer covered $843.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-07-22
- Stop
- 2010-07-22
The parties
- Patient
- patient Augustina Ana Shanahan
- Provider
- provider Matt Shanahan
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
314bf5ed-ef43-7062-0ecd-ebd6e77918de