Claim CLM-9842311
Patient: Henderson, Patricia · DOS: 04/22/2026 · Payer: Highmark BCBS
| Line | Service Date | CPT | Description | Modifiers | Amount | Status |
|---|---|---|---|---|---|---|
| 1 | 04/22/2026 | 99214 | Office Visit Est Pt Level 4 | — | $185.00 | OK |
| 2 | 04/22/2026 | 93000 | Electrocardiogram, complete | — | $45.00 | ERROR |
| 3 | 04/22/2026 | 85025 | CBC w/ Differential | — | $22.00 | ERROR |
| 4 | 04/22/2026 | 80053 | Comp Metabolic Panel | — | $24.00 | OK |
| Total | $276.00 | |||||