Claim total
$1,714.37
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2025-09-01
- Stop
- 2025-09-01
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-9ce6-617a56ba91a9