A123456785 “,” DOE, JANE “,” 08/10/16 ”,” 319.25 ”,” 23.00 "," 54.27 ”,” CLMPD ”,”  Claim paid correctly per  ”,”  08/15/17 ”,”  BAR.ID  ”,” HMO    
A123456786 “,” DOE, JANE “,” 08/10/16 ”,”        ”,” 23.00 "," 54.27 ”,” CLMPD ”,”                                                  ”,”  08/15/17 ”,” BAR.ID  ”,”  HMO    
A123456787 “,” DOE, JANE “,”08/10/16 ”,” 319.25 ”,”        "," 54.27 ”,” CLMPD  ”,” Contract Calculation-        ”,”  08/15/17 ”,”  BAR.ID ”,” PPO