Claim total
$847.72
base $93.83 · payer covered $593.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-02-09
- Stop
- 2016-02-09
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Jan Nicolas
- Payer
- payer Cigna Health
Record id
03f9d33d-12ca-f1a8-fabd-c8c13e9f13be