Claim CLM-20261016002
$45.86
billed
$32.10
allowed
$0.00
paid
$32.10
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Acetaminophen 160 MG Chewable Tablet | 313820 | $0.00 | $0.00 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Acetaminophen 160 MG Chewable Tablet | 313820 | $0.00 | $0.00 |