Claim CLM-G0104598
$119.35
billed
$72.58
allowed
$96.92
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Office visit, established patient, level 3 | 99213 | $119.35 | $96.92 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Office visit, established patient, level 3 | 99213 | $119.35 | $96.92 |