Claim CLM-G0101631
$156.93
billed
$118.95
allowed
$72.93
paid
$15.83
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Office visit, established patient, level 3 | 99213 | $156.93 | $72.93 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Office visit, established patient, level 3 | 99213 | $156.93 | $72.93 |