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
- 2020-04-06
- Stop
- 2020-04-06
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
11a50515-48c1-9cb9-6207-0040e62194e0