Claim total
$835.68
base $93.39 · payer covered $785.68
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2017-08-20
- Stop
- 2017-08-20
The parties
- Patient
- patient Jesse Roosevelt Wolf
- Provider
- provider Tiffany Smitham
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
26aa011e-0d75-d1a3-3f1a-e590bb0bcb0d