Claim CLM-G0149247
$114.68
billed
$72.72
allowed
$68.53
paid
$1.14
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Chest radiograph, 2 views | 71046 | $114.68 | $68.53 |
| Service | Code | Billed | Paid |
|---|---|---|---|
| Chest radiograph, 2 views | 71046 | $114.68 | $68.53 |