Claim total
$1,772.37
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of mandible263172003
- Start
- 2016-11-20
- Stop
- 2016-11-20
The parties
- Patient
- patient Long Lee Koelpin
- Provider
- provider Jeremy Veum
- Care site
- care site THE VILLA AT BRYN MAWR
- Payer
- payer Cigna Health
Record id
3262d190-0790-ed5d-8104-785183bbd508