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

Claim CLM-2026501007

Ivan Anatoly Gomez MRN-103707 Payer Aetna Service Dec 12, 2023 Status paid
$347.47
billed
$243.23
allowed
$0.00
paid
$243.23
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Ibuprofen 100 MG Oral Tablet198405 $0.00 $0.00