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