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Steven Eagleheart MRN-204023 · born 1928-06-08 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-G0104354

Steven Eagleheart MRN-204023 Payer Humana Service Dec 19, 2024 Status paid
$94.33
billed
$53.49
allowed
$69.06
paid
$0.00
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Telehealth visit, level 399213 $94.33 $69.06