VISIT SUMMARY
Life Steps OblGyn Healthcare For Women. Date
LLP May 23, 2017
Account ID:
Chart ID:
Coverage Insurance Policy ID
agnosis:
SERVICES
Date Claim-lineProvider Units Mod Description Charges Payments Adjusts Balance
5/23/17 1 305.00 305.00
5/23/17 I 35.00 35.00
923/17 1 40.00 40.00
5/23/17 I 25.00 25.00
523/17 i 30.00 30.00
923/17 I 25.00 25.00
5123/17 I 25.00 25.00
5/23/17 1 20.00 20.00
EFTA00313698