Claim total
$989.45
base $93.83 · payer covered $791.55
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-04-07
- Stop
- 2026-04-08
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Jan Nicolas
- Payer
- payer Anthem
Record id
03f9d33d-12ca-f1a8-4967-c3f473a53a1a