View Charges
| Diagnosis Codes | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Charge ID | Case | Date of Service |
Start of Care | CPT Code | Units | Modifier 1 | Modifier 2 | Modifier 3 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Insurance Preauthorization |
Current Insurance |
Charge Amount |
Payment Amount |
Adjustment Amount |
Date Last Billed |
|
| 141162370 | Foot pain, left foot - 05/01/2016 - Eff: 7/10/2016 | 07/20/2018 | 07/23/2018 | 97001 | 1 | RT | GY | L97421 | L97421 | L97421 | L97421 | L97421 | L97421 | L97421 | L97421 | 356-07122016 | Medicare Secondary Payer | $122.00 | $100.00 | $5.00 | 06/15/2018 | ||
| 141162370 | Foot pain, left foot - 05/01/2016 - Eff: 7/10/2016 | 07/20/2018 | 07/23/2018 | 97001 | 1 | RT | GY | L97421 | L97421 | L97421 | L97421 | L97421 | L97421 | L97421 | L97421 | 356-07122016 | Medicare Secondary Payer | $122.00 | $100.00 | $5.00 | 06/15/2018 | ||
| Total | 3 | $244.00 | $200.00 | $10.00 | |||||||||||||||||||