Claim total
$4,516.55
base $93.39 · payer covered $4,466.55
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- diagnosis concept Child attention deficit disorder192127007
- Start
- 2025-10-11
- Stop
- 2025-10-11
The parties
- Patient
- patient Cristobal Dana Wolf
- Provider
- provider Quincy Koelpin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
016cc0d6-9a88-e8dc-fc51-7fda241b70fd