Claim total
$6,923.62
base $127.17 · payer covered $6,873.62
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 1991-01-19
- Stop
- 1991-01-19
The parties
- Patient
- patient Jon Lavern Baumbach
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Medicaid
Record id
033f4a7e-c2bc-1f12-ce31-e02ba663d196