Claim total
$5,048.62
base $127.17 · payer covered $4,998.62
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 1993-10-20
- Stop
- 1993-10-20
The parties
- Patient
- patient Soledad Rocio Aguirre
- Provider
- provider Shellie Pacocha
- Care site
- care site MILS HOME HEALTH CARE AGENCY
- Payer
- payer Medicaid
Record id
060aa7a8-9653-5ae4-1d2f-4e7cba907e86