Claim CLM-2026088002
$11,451.02
billed
$10,403.76
allowed
$9,046.75
paid
$1,357.01
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Prenatal visit (regime/therapy) | 424619006 | $0.00 | $0.00 |
| Evaluation of uterine fundal height (procedure) | 274804006 | $9,046.75 | $6,332.72 |
| Auscultation of the fetal heart (procedure) | 225158009 | $2,261.69 | $1,583.18 |