Claim CLM-G0101853
$248.14
billed
$150.64
allowed
$164.56
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Office visit, new patient | 99204 | $248.14 | $164.56 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Office visit, new patient | 99204 | $248.14 | $164.56 |