Claim total
$1,869.60
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-02-14
- Stop
- 2017-02-14
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Jan Nicolas
- Payer
- payer Cigna Health
Record id
03f9d33d-12ca-f1a8-cfd9-a24eace532f3