Claim CLM-G0127248
$180.87
billed
$128.18
allowed
$114.81
paid
$3.53
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Telehealth visit, level 3 | 99213 | $145.27 | $86.78 |
| Hemoglobin A1c | 83036 | $35.60 | $28.03 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Telehealth visit, level 3 | 99213 | $145.27 | $86.78 |
| Hemoglobin A1c | 83036 | $35.60 | $28.03 |