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Daniel Chen Merriweather MRN-202387 · born 1999-12-14 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-G0101852

Daniel Chen Merriweather MRN-202387 Payer Medicaid Service Apr 10, 2025 Status paid
$136.59
billed
$122.26
allowed
$76.58
paid
$19.00
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Office visit, established patient, level 399213 $107.13 $53.21
Complete blood count85025 $29.46 $23.37