Claim total
$30,790.87
base $127.17 · payer covered $30,740.87
The visit
- Class
- Inpatient
- Code
- 397821002
- Reason
- diagnosis concept History of coronary artery bypass grafting399261000
- Start
- 2025-01-08
- Stop
- 2025-01-14
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-af28-a84acef376a7