Claim total
$6,510.44
base $127.17 · payer covered $6,460.44
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 1990-02-02
- Stop
- 1990-02-02
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Medicaid
Record id
0465c17f-66cb-2155-e5c7-2d9206262dea