$\backslash$table$[[$DATE$,$CODE,DESCRIPTION,CHARGES,CREDITS$],[09/08/29,99202,$New patient, straightforward,$75\mathrm{.}00,],[09/08/29,85008,$Blood smear w$/$o diff WBC count,$14\mathrm{.}00,],[09/08/29,81000,$Urinalysis,$17\mathrm{.}00,],[09/09/29,,$Golden Rule Ins. Co$.$ #$31478$ Filed,,$],[10/15/29,,$Denied Golden Rule Ins. Co$.$ #$31478,,00\mathrm{.}00],[10/15/29,,\backslash$table$[[$Repriced Golden Rule Ins. Co$.],[$#$31478]],,25\mathrm{.}00-$