Claim total
$711.72
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-01-19
- Stop
- 2010-01-19
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Jan Nicolas
- Payer
- payer Cigna Health
Record id
03f9d33d-12ca-f1a8-934e-ac5e95186bb9