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In context Elizabeth Otieno MRN-228768 · born 1940-09-22 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-G0142836

Elizabeth Otieno MRN-228768 Payer Medicare Service Jul 4, 2025 Status paid
$299.72
billed
$198.09
allowed
$215.70
paid
$0.00
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Comprehensive metabolic panel80053 $46.53 $27.38
Preventive visit, established patient99396 $253.19 $188.32