Claim total
$42,919.83
base $155.66 · payer covered $22,762.94
The visit
- Class
- Ambulatory
- Code
- 424441002
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2020-01-04
- Stop
- 2020-01-04
The parties
- Patient
- patient Charlyn Gaylord
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Aetna
Record id
06497b58-bf50-66ab-df0c-4d2865876d2b