Claim CLM-G0112748
$92.83
billed
$52.86
allowed
$66.37
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Comprehensive metabolic panel | 80053 | $46.30 | $34.18 |
| Electrocardiogram, routine | 93000 | $46.53 | $32.19 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Comprehensive metabolic panel | 80053 | $46.30 | $34.18 |
| Electrocardiogram, routine | 93000 | $46.53 | $32.19 |