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Date 01/05/2023 Code 90025 Code 10001 Chargges 349.00 75.00 Contractual allowance 200.00 25.00 Adjustment 0.00 0.00 Allowable charge 149.00 50.00 Co insurance 0.00 0.00 Payment

Date 01/05/2023 Code 90025 Code 10001 Chargges 349.00 75.00 Contractual allowance 200.00 25.00 Adjustment 0.00 0.00 Allowable charge 149.00 50.00 Co insurance 0.00 0.00 Payment 110.00 0.00 What is the total charges? What is the amount denied? What is the amount recovered

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