Claim details

Riverside Surgical Center

Outpatient surgery · Jun 13, 2026

In-network

Cost breakdown

Billed amount$2000

Allowed amount$1400

Copay$0

Applied to deductible$1400

Applied to coinsurance$0

Plan paid$0

You owe (per EOB)$1400

Claim CLM-260613-004

See the coverage rules behind this claim's copay and deductible.

Outpatient surgery

30% coinsurance applies · Medical · Procedures