Claim CLM-G0142836
$299.72
billed
$198.09
allowed
$215.70
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Comprehensive metabolic panel | 80053 | $46.53 | $27.38 |
| Preventive visit, established patient | 99396 | $253.19 | $188.32 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Comprehensive metabolic panel | 80053 | $46.53 | $27.38 |
| Preventive visit, established patient | 99396 | $253.19 | $188.32 |