Claim total
$13,330.37
base $127.17 · payer covered $13,280.37
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 1990-03-05
- Stop
- 1990-03-05
The parties
- Patient
- patient Santa Antonina Bernier
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Medicaid
Record id
051f1153-ae45-1425-f617-bf44ccf050df