Date,CPT_Code,Description,Charged_Amount,Allowed_Amount,Plan_Paid,Patient_Responsibility
2024-04-15,74177,CT Abdomen/Pelvis w/contrast,1847.50,1200.00,960.00,240.00
2024-03-22,99213,Office visit established patient,185.00,120.00,96.00,24.00
2024-02-10,80061,Lipid panel,82.00,55.00,44.00,11.00
2024-01-18,99395,Preventive visit adult,310.00,250.00,250.00,0.00
2023-12-05,90686,Influenza vaccine,55.00,40.00,40.00,0.00
2023-11-12,87880,Strep A direct test,42.00,28.00,22.40,5.60
2023-10-08,71046,Chest X-ray 2 views,210.00,140.00,112.00,28.00
2023-09-22,93000,Electrocardiogram complete,138.00,90.00,72.00,18.00
2023-08-14,99214,Office visit established mod complexity,250.00,170.00,136.00,34.00
2023-07-03,36415,Venipuncture,18.00,12.00,9.60,2.40