Claim total
$704.41
base $93.83 · payer covered $72.17
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-04-01
- Stop
- 2025-04-02
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Nestor Kling
- Payer
- payer Anthem
Record id
03f9d33d-12ca-f1a8-4412-3f5a028d2806