Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2025-07-19
- Stop
- 2025-07-19
The parties
- Patient
- patient Dorotea Yolanda Palomo
- Provider
- provider Jeremy Veum
- Care site
- care site THE VILLA AT BRYN MAWR
- Payer
- payer Medicaid
Record id
04ad2732-b952-4fbb-cb2e-aebadb926be0