Claim CLM-20261101004
$45,305.17
billed
$41,549.58
allowed
$36,130.07
paid
$5,419.51
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Prenatal initial visit (regime/therapy) | 424441002 | $0.00 | $0.00 |
| Normal pregnancy (finding) | 72892002 | $0.00 | $0.00 |
| Standard pregnancy test (procedure) | 252160004 | $5,091.75 | $3,564.22 |
| Ultrasound scan for fetal viability (procedure) | 169230002 | $7,349.26 | $5,144.48 |