Claim CLM-2026185005
$234.71
billed
$137.23
allowed
$119.33
paid
$17.90
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Follow-up encounter (procedure) | 390906007 | $0.00 | $0.00 |
| Comprehensive metabolic 2000 panel - Serum or Plasma | 24323-8 | $74.58 | $52.21 |
| Lipid panel with direct LDL - Serum or Plasma | 57698-3 | $74.58 | $52.21 |