Charges
03/04/2019
Group Health CooperativeMC
No Secondary Insurance
No Tertiary Insurance
Charge Detail
| Status | CPT Code | Units | Amount | Modifier 1 | Modifier 2 | Modifier 3 | Diagnosis Code(s) | Total Amount | |
|---|---|---|---|---|---|---|---|---|---|
| New |
|
$99,999.99 | |||||||
| New |
|
$99,999.99 | |||||||
| New |
|
$99,999.99 | |||||||
| New |
|
$99,999.99 |
Diagnosis
At least one ICD-10 code is required
| No. | ICD-10 Code | Description | |
|---|---|---|---|
| 1 | L97421 | Non-pressure chronic ulcer of left heel and midfoot limited to breackdown of skin | |
| 1 | L97421 | Non-pressure chronic ulcer of left heel and midfoot limited to breackdown of skin |