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Alejandra Abebe MRN-227559 · born 1985-01-01 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-G0140941

Alejandra Abebe MRN-227559 Payer Medicaid Service Jun 25, 2026 Status paid
$22.20
billed
$12.28
allowed
$10.21
paid
$0.72
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Complete blood count85025 $22.20 $10.21