Claim total
$14,992.44
base $155.66 · payer covered $14,942.44
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2025-12-06
- Stop
- 2025-12-06
The parties
- Patient
- patient Cristobal Dana Wolf
- Provider
- provider Richard Ledner
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
016cc0d6-9a88-e8dc-bb5f-66768174d01c