Claim total
$11,697.49
base $155.66 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2026-06-22
- Stop
- 2026-06-22
The parties
- Patient
- patient Chantay Victorina Koepp
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
00c59201-9d52-fccb-fb47-a1d9cc3ce2ad