Claim total
$286.29
base $93.39 · payer covered $236.29
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2021-07-24
- Stop
- 2021-07-24
The parties
- Patient
- patient Mary Teodoro Rutherford
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
250f5ef4-c14c-ed2f-ae22-b1c8be7baaa8