Overview
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Aetna · Service date Aug 15, 2026 · Dr. Marcus Byrne
MRN MRN-PAT-GEN-92 · 75 yrs
MRN MRN-PAT-GEN-92 · 75 yrs
No secondary insurance on file for this patient.
No non-insurance payers (foundations, grants, cash pay) are linked to this claim.
Credentialing status unavailable for this provider.
No referring or supervising providers are attached to this encounter.
No additional submission details (referral numbers, authorization numbers, accident information) on this claim.
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 |
|---|---|---|---|---|---|---|---|
| Aug 15, 2026 | 70551 | — | E78.5 | 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 |
|---|---|---|---|
| Aug 20, 2026 | Northstar Family Health - Main | Paid | $320.00 |
| Aug 13, 2026 | Northstar Family Health - Main | Rejected | $1,400.00 |
| Aug 14, 2026 | Northstar Family Health - Main | Paid | $55.00 |
| Aug 11, 2026 | Northstar Family Health - Main | Paid | $320.00 |
| Aug 8, 2026 | Northstar Family Health - Main | Coded | $45.00 |
| Jul 26, 2026 | Northstar Family Health - Main | ERA received | $300.00 |
| Aug 10, 2026 | Northstar Family Health - Main | Paid (incorrect) | $240.00 |
| Aug 5, 2026 | Northstar Family Health - Main | Submitted | $1,800.00 |