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Preventive CareEOB-2024-001098
Dr. Sarah Johnson, MD
Service Date: August 14, 2024
$189.00
Total Charged
Financial Breakdown
$189.00
Total Charged
$189.00
Medicare Paid
$0.00
You Paid
Service Details
Services Provided
| Service | Code | Qty | Charged | Allowed | Paid |
|---|---|---|---|---|---|
| Office visit, established patient, moderate complexity | 99213 | 1 | $189.00 | $160.65 | $189.00 |
Diagnosis Information
Primary Diagnosis
Z00.00
Encounter for general adult medical examination without abnormal findings
Provider Information
- Provider:
- Dr. Sarah Johnson, MD
- Provider Type:
- Primary Care
- NPI:
- 1234567890
- Facility:
- Denver Family Medicine
- Place of Service:
- Office (11)
Claim Information
- Claim ID:
- EOB-2024-001098
- Service Date:
- August 14, 2024
- End Date:
- August 14, 2024
- Processed Date:
- August 18, 2024
- Status:
- APPROVED
Coverage Analysis
Medicare Coverage
Covered Service
Part BPreventive Care
100% CoveredThis service is covered under your Medicare plan. No deductible was applied.
Cost Breakdown
Provider Charged:$189.00
Medicare Allowed:$160.65
Medicare Paid:$189.00
Your Responsibility:$0.00
AI Analysis
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