HCI Prototype by Abel Pech
Pre-Care Cost Estimator
EOB Simplifier
Before you book
What will this
actually cost me?
Service
MRI — knee, without contrast
Annual physical
Specialist visit (out-of-network)
Provider / facility
Westside Imaging Center
City General Hospital
Your plan
See my estimate
You'll likely owe
$340–$420
After your $200 deductible (already met) and 20% coinsurance
Confirmed
Estimated
Unknown
Heads up —
Westside Imaging bills radiology reads through a separate out-of-network group. That portion isn't guaranteed.
Facility fee
Confirmed
$280
Radiologist read
Estimated
$60–$140
Contrast (if used)
Unknown
Estimate built from your plan's allowed amounts and this facility's last 90 days of claims.
See how this number was calculated →
EOB · June 14 visit
What happened
with this claim
Plain
Raw EOB
You owe
$84.20
for this visit — less than your usual copay.
3 line items
1 needs your attention
Office visit
$0.00
Fully covered. Your insurance paid the full allowed amount of $145 — you owe nothing for this part.
CPT 99213 · Billed $210.00 · Allowed $145.00 · Plan paid $145.00 · Patient resp $0.00
Lab work (bloodwork)
$84.20
Partially covered. Insurance paid 80% — you owe the remaining 20% coinsurance.
CPT 80053 · Billed $120.00 · Allowed $105.00 · Plan paid $84.00 · Patient resp $21.00
Vitamin D screening
Denied
⚠️
Why:
Your plan only covers this test once every 12 months, and you had one in February.
This looks wrong → start an appeal
CPT 82306 · Denial code CO-119 · Billed $65.00 · Allowed $0.00 · Patient resp $65.00