Claims
Billed
$550.00
Allowed
$460.00
Approved
$460.00
Member Resp.
$90.00
Claim Details
- Provider
- Dr. James Lee
- Service Date
- Mar 5, 2026
- Submitted
- Mar 6, 2026
- Auto-Adjudicated
- Yes
Member
Service Lines
| # | CPT | Description | Billed | Allowed | Approved | Member Resp. |
|---|---|---|---|---|---|---|
| 1 | 99213 | Office visit, established patient (level 3) | $180.00 | $110.00 | $110.00 | $70.00 |
| 2 | 36415 | Routine venipuncture | $30.00 | $8.00 | $8.00 | $22.00 |
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