Claim CLM-2026185000
$4,052.91
billed
$3,597.50
allowed
$3,128.26
paid
$469.24
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Patient encounter procedure (procedure) | 308335008 | $0.00 | $0.00 |
| Removal of subcutaneous contraceptive (procedure) | 301807007 | $3,910.33 | $2,737.23 |