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In context Francisco Tallchief MRN-210370 · born 2004-04-03 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-G0114252

Francisco Tallchief MRN-210370 Payer Cigna Service Aug 29, 2024 Status paid
$217.94
billed
$121.40
allowed
$158.93
paid
$0.00
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Office visit, established patient, level 499214 $217.94 $158.93