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Blue Cross Blue Shield · Service date Oct 30, 2026 · Dr. Hannah Cole
MRN MRN-PAT-GEN-33 · 33 yrs
Credentialing status unavailable for this provider.
Encounter-level place of service is the code on Box 24B of the CMS-1500. Per-line overrides appear in the Service lines table below.
| Date of service | CPT code | Modifiers | Diagnoses | Place of service | Qty | Billed | Details |
|---|---|---|---|---|---|---|---|
| Oct 30, 2026 | 70551 | — | Z00.00 | 11 - Office | 1 | $2,200.00 | |
Allowed— Pri ins paym$0.00 Pri ins adj— Pat resp$0.00 Pat bal$0.00 Bal$2,200.00 | |||||||
Date of service | Facility | Status | Billed |
|---|---|---|---|
Northstar Family Health - Main | ERA received | $400.00 | |
Northstar Family Health - Main | Awaiting info | $1,800.00 | |
Northstar Family Health - Main | Paid | $4,800.00 | |
Northstar Family Health - Main | Coded | $240.00 | |
Northstar Family Health - Main | Paid | $55.00 | |
Northstar Family Health - Main | Paid | $45.00 | |
Northstar Family Health - Main | Paid | $240.00 |