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Chanelle Janine Kling MRN-101453 · born 1963-10-20 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-2026179002

Chanelle Janine Kling MRN-101453 Payer Aetna Service Sep 6, 2025 Status paid
$38.58
billed
$27.01
allowed
$0.00
paid
$27.01
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Hydrochlorothiazide 25 MG Oral Tablet310798 $0.00 $0.00
Therapeutic injection/administration96372 $38.13 $26.69