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In context Mato Yellowhair MRN-202238 · born 1985-02-12 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-G0101631

Mato Yellowhair MRN-202238 Payer UnitedHealthcare Service Mar 20, 2025 Status paid
$156.93
billed
$118.95
allowed
$72.93
paid
$15.83
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Office visit, established patient, level 399213 $156.93 $72.93