Claim CLM-2026088006
$6,207.54
billed
$5,579.76
allowed
$4,851.97
paid
$727.79
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Prenatal visit (regime/therapy) | 424619006 | $0.00 | $0.00 |
| Evaluation of uterine fundal height (procedure) | 274804006 | $2,261.69 | $1,583.18 |
| Auscultation of the fetal heart (procedure) | 225158009 | $2,261.69 | $1,583.18 |
| Detection of chromosomal aneuploidy in prenatal amniotic fluid specimen using fluorescence in situ hybridization screening technique (procedure) | 443529005 | $1,541.58 | $1,079.11 |