Claim CLM-2026951007
$1,199.60
billed
$839.72
allowed
$0.00
paid
$839.72
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Digoxin 0.125 MG Oral Tablet | 197604 | $0.00 | $0.00 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Digoxin 0.125 MG Oral Tablet | 197604 | $0.00 | $0.00 |