Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2026-04-07
- Stop
- 2026-04-07
The parties
- Patient
- patient Thersa Carisa Connelly
- Provider
- provider Jeremy Veum
- Care site
- care site THE VILLA AT BRYN MAWR
- Payer
- payer Dual Eligible
Record id
282d5f3b-9341-0a9d-2128-facaaae62f3b