Claim CLM-2026206006
$516.95
billed
$396.89
allowed
$345.12
paid
$51.77
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Encounter for problem (procedure) | 185347001 | $0.00 | $0.00 |
| Rehabilitation therapy (regime/therapy) | 52052004 | $431.40 | $301.98 |