Claim total
$1,864.14
base $93.83 · payer covered $1,764.14
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-11-02
- Stop
- 2023-11-02
The parties
- Patient
- patient Ezekiel Demarcus Roob
- Provider
- provider Renato Bahringer
- Care site
- care site TWIN CITIES MEDICAL CLINIC PC
- Payer
- payer Medicaid
Record id
2e1a22fb-46ba-3fcc-5c13-0df03f3e93ff