Claim total
$16,423.32
base $127.17 · payer covered $16,373.32
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 1991-11-05
- Stop
- 1991-11-05
The parties
- Patient
- patient Elinore Danyelle Streich
- Provider
- provider Shellie Pacocha
- Care site
- care site MILS HOME HEALTH CARE AGENCY
- Payer
- payer Medicaid
Record id
03b3068a-a726-461a-9a54-f25c92c2fe7f