Claim total
$11,949.04
base $155.66 · payer covered $11,899.04
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2026-04-12
- Stop
- 2026-04-12
The parties
- Patient
- patient Cristobal Dana Wolf
- Provider
- provider Malena Wilderman
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
016cc0d6-9a88-e8dc-0bd3-b87a615436cd