Claim CLM-2026077005
$129.94
billed
$90.96
allowed
$0.00
paid
$90.96
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| carvedilol 25 MG Oral Tablet | 200033 | $0.00 | $0.00 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| carvedilol 25 MG Oral Tablet | 200033 | $0.00 | $0.00 |