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Charline Paucek MRN-101495 · born 1975-08-28 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-2026185004

Charline Paucek MRN-101495 Payer UnitedHealthcare Service Jun 12, 2025 Status paid
$35.93
billed
$25.15
allowed
$0.00
paid
$25.15
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Simvastatin 10 MG Oral Tablet314231 $0.00 $0.00
Therapeutic injection/administration96372 $35.63 $24.94