Claim CLM-G0146582
$586.47
billed
$325.22
allowed
$341.49
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Office visit, new patient | 99204 | $235.39 | $137.87 |
| Office visit, established patient, level 3 | 99213 | $96.50 | $46.01 |
| Office visit, new patient | 99204 | $254.58 | $157.61 |