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

Claim CLM-2026501005

Ivan Anatoly Gomez MRN-103707 Payer Aetna Service Mar 30, 2024 Status paid
$85.55
billed
$59.88
allowed
$0.00
paid
$59.88
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Encounter for symptom (procedure)185345009 $0.00 $0.00
Otitis media (disorder)65363002 $0.00 $0.00