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Rolf Marlin Grant MRN-106857 · born 1935-05-13 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-2026951001

Rolf Marlin Grant MRN-106857 Payer Humana Service Apr 6, 2026 Status paid
$129.94
billed
$90.96
allowed
$0.00
paid
$90.96
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
tropicamide 5 MG/ML Ophthalmic Solution313521 $0.00 $0.00