Claim total
$93.39
base $93.39 · payer covered $43.39
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Chronic pain82423001
- Start
- 2014-03-20
- Stop
- 2014-03-20
The parties
- Patient
- patient Ricky Michal Wisozk
- Provider
- provider Tiffany Smitham
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
1ed700c5-df9c-e290-9fec-552518d62a1e