Claim total
$1,701.86
base $127.17 · payer covered $1,361.48
The visit
- Class
- Inpatient
- Code
- 32485007
- Reason
- —
- Start
- 2025-12-24
- Stop
- 2025-12-25
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Alene Legros
- Payer
- payer Anthem
Record id
03f9d33d-12ca-f1a8-6a83-8adf7fe90051