Claim CLM-G0138539
$149.87
billed
$86.07
allowed
$103.54
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Chest radiograph, 2 views | 71046 | $149.87 | $103.54 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Chest radiograph, 2 views | 71046 | $149.87 | $103.54 |