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In context Elena Pilar Gomez MRN-101642 · born 1950-12-16 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-2026206003

Elena Pilar Gomez MRN-101642 Payer UnitedHealthcare Service Jan 9, 2026 Status paid
$32.49
billed
$22.74
allowed
$0.00
paid
$22.74
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Alendronic acid 10 MG Oral Tablet904419 $0.00 $0.00
Therapeutic injection/administration96372 $30.36 $21.25