Claim CLM-2026245003
$129.94
billed
$90.96
allowed
$0.00
paid
$90.96
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| tropicamide 5 MG/ML Ophthalmic Solution | 313521 | $0.00 | $0.00 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| tropicamide 5 MG/ML Ophthalmic Solution | 313521 | $0.00 | $0.00 |