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In context Ashlee Leon Mann MRN-100739 · born 1983-02-23 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-2026077005

Ashlee Leon Mann MRN-100739 Payer Medicare Service Nov 11, 2025 Status paid
$129.94
billed
$90.96
allowed
$0.00
paid
$90.96
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
carvedilol 25 MG Oral Tablet200033 $0.00 $0.00