Claim CLM-2026173004
$36.76
billed
$25.73
allowed
$0.00
paid
$25.73
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| amLODIPine 2.5 MG Oral Tablet | 308136 | $0.00 | $0.00 |
| Therapeutic injection/administration | 96372 | $35.39 | $24.77 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| amLODIPine 2.5 MG Oral Tablet | 308136 | $0.00 | $0.00 |
| Therapeutic injection/administration | 96372 | $35.39 | $24.77 |