Claim total
$775.00
base $93.83 · payer covered $775.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-03-09
- Stop
- 2021-03-09
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Jan Nicolas
- Payer
- payer Aetna
Record id
03f9d33d-12ca-f1a8-b304-6e68db5678ca