VISIT SUMMARY
Life Steps Ob/Gyn Healthcare For Women. Date
LLP May 23, 2017
Account ID:
Chart ID:
Coverage Insurance Policy ID
lagnosis:
SERVICES
Date Claim-Line Provider Units Mod Description Charges Payments Adjusts Balance
5/23/17 305.00 305.00
5/23/17 35.00 35.00
5/23/17 40.00 40.00
5/23/17 25.00 25.00
523/17 30.00 30.00
5/23/17 25.00 25.00
923/17 25.00 25.00
923/17 20.00 20.00
EFTA00313691