Claims
Billed
$1,850.00
Allowed
$1,500.00
Approved
$1,000.00
Member Resp.
$500.00
Claim Details
- Provider
- Pulmonary Associates
- Service Date
- Mar 10, 2026
- Submitted
- Mar 11, 2026
- Auto-Adjudicated
- Yes
Member
Diagnosis Codes
J45.30— Mild persistent asthma, uncomplicated(Principal)R06.02— Shortness of breath
Service Lines
| # | CPT | Description | Billed | Allowed | Approved | Member Resp. |
|---|---|---|---|---|---|---|
| 1 | 99214 | Office visit | $250.00 | $165.00 | $165.00 | $85.00 |
| 2 | 90837 | Pulmonary function test | $280.00 | $175.00 | $175.00 | $105.00 |
Adjudication Trace
Fee schedule lookup
Eligibility check
Notes (0)
No notes yet.
Attachments (0)
No attachments yet.
PDF, TIFF, PNG, or JPG