Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2013-10-22
- Stop
- 2013-10-22
The parties
- Patient
- patient Matt Stanton Brown
- Provider
- provider Rupert O'Conner
- Care site
- care site PARKWAY FAMILY PHYSICIANS
- Payer
- payer Medicaid
Record id
04e52287-fbd6-ff57-4d4f-ea1afdb07744