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
- 2021-04-07
- Stop
- 2021-04-07
The parties
- Patient
- patient Jarod Clyde Sipes
- Provider
- provider Jeremy Veum
- Care site
- care site THE VILLA AT BRYN MAWR
- Payer
- payer Medicaid
Record id
32122cd6-5f93-fb84-c88c-23c225a7a3c8