Claim CLM-2026634003
$11,150.24
billed
$10,127.05
allowed
$8,806.13
paid
$1,320.92
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Outpatient procedure (procedure) | 371883000 | $0.00 | $0.00 |
| Subcutaneous immunotherapy (procedure) | 180256009 | $11,007.66 | $7,705.36 |