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Veronica Josefina Gomez MRN-107312 · born 2021-07-20 ✦ AI Ask ✦ AI Ambient note Chart

Claim CLM-20261016002

Veronica Josefina Gomez MRN-107312 Payer Medicaid Service Jan 13, 2026 Status paid
$45.86
billed
$32.10
allowed
$0.00
paid
$32.10
patient responsibility

Adjudication lines

ServiceCodeBilled Paid
Acetaminophen 160 MG Chewable Tablet313820 $0.00 $0.00