Claim total
$93.39
base $93.39 · payer covered $58.39
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2025-04-17
- Stop
- 2025-04-17
The parties
- Patient
- patient Rafael Jacob Stark
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Dual Eligible
Record id
317ac6ea-e6de-31fb-105e-153ddd693c2e