Claim total
$846.78
base $93.83 · payer covered $746.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-11-26
- Stop
- 2024-11-26
The parties
- Patient
- patient Matt Stanton Brown
- Provider
- provider Jeffrey Breitenberg
- Care site
- care site PARKWAY FAMILY PHYSICIANS
- Payer
- payer Medicaid
Record id
04e52287-fbd6-ff57-c923-98855e53a4d7