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
- 2003-10-08
- Stop
- 2003-10-08
The parties
- Patient
- patient Candyce Isabel Gutkowski
- Provider
- provider Jeremy Veum
- Care site
- care site THE VILLA AT BRYN MAWR
- Payer
- payer No insurance
Record id
32da48b4-09cc-d935-0a7e-83ebd26da27e