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In context Ivan Anatoly Gomez MRN-103707 · born 2019-04-12 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-2026501004

Ivan Anatoly Gomez MRN-103707 Payer Aetna Service Mar 30, 2024 Status paid
$45.31
billed
$31.72
allowed
$0.00
paid
$31.72
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Amoxicillin 500 MG Oral Tablet308192 $0.00 $0.00
Therapeutic injection/administration96372 $40.15 $28.11