Claim total
$3,935.75
base $127.17 · payer covered $2,940.42
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2026-01-24
- Stop
- 2026-01-24
The parties
- Patient
- patient Otelia Kelsi Grant
- Provider
- provider Jeremy Veum
- Care site
- care site THE VILLA AT BRYN MAWR
- Payer
- payer UnitedHealthcare
Record id
11a50515-48c1-9cb9-5a38-0cc2f691e1bb