Claim CLM-2026501005
$85.55
billed
$59.88
allowed
$0.00
paid
$59.88
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Encounter for symptom (procedure) | 185345009 | $0.00 | $0.00 |
| Otitis media (disorder) | 65363002 | $0.00 | $0.00 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Encounter for symptom (procedure) | 185345009 | $0.00 | $0.00 |
| Otitis media (disorder) | 65363002 | $0.00 | $0.00 |