Claim total
$663.77
base $93.39 · payer covered $613.77
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2025-05-16
- Stop
- 2025-05-16
The parties
- Patient
- patient Sebastian Lavern Brown
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
36deb4e8-cfd4-07d1-7d70-c2164641e225