Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2017-01-02
- Stop
- 2017-01-02
The parties
- Patient
- patient Sharie Ginger Jacobson
- Provider
- provider Jeremy Veum
- Care site
- care site THE VILLA AT BRYN MAWR
- Payer
- payer Humana
Record id
219af15c-aacc-5a33-5d17-c5f77f485393