Claim total
$16,338.20
base $127.17 · payer covered $16,288.20
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 1994-06-07
- Stop
- 1994-06-07
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
060aa7a8-9653-5ae4-2213-12edcc09ca5d