Claim total
$1,152.69
base $93.83 · payer covered $1,052.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-11-23
- Stop
- 2021-11-23
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-ff57-7808-89b41355cb0b