Claim total
$1,772.37
base $127.17 · payer covered $1,722.37
The visit
- Class
- Inpatient
- Code
- 305342007
- Reason
- diagnosis concept History of coronary artery bypass grafting399261000
- Start
- 2025-01-14
- Stop
- 2025-01-15
The parties
- Patient
- patient Joe Maximo Kozey
- Provider
- provider Lilia Montañez
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
0135e6bd-cd4d-6318-715c-b479ede6fb4f