Life Steps Ob/Gyn Healthcare For Women,

Life Steps Ob/Gyn Healthcare For Women, LLP 60 EAST END AVENUE New York, NY, 10028 Phone 212-860-4800 )lagnosis: SERVICES October 18, 2016 Account ID: 14159 Chart ID: 14159 Coverage Insurance Policy ID Date Claim-Line Provider X Ref CPT Units Mod 10/18/16 63450-1 Dr. Karen KIRSCH &WC 99213 1 10/18/16 Paid On. 10/18116 10/18/16 81159.2 Dr. Karen KIRSCH A 90636 1 10/18/16 Paid On 10/18/16 10/18/16 63459.3 Dr. Karen KIRSCH A 90471 1 10/18/16 Paid On 10/18/16 Description Charges Payments Adjusts Balance Subseo visit lid 250.00 0.00 Paid Patient Payment - Cr 250.00 125.00 0.00 Paid Patient Payment - Cr 125.00 75.00 0.00 Patd Patent Payment - Cr 75.00 Balance : 0.00 RECEIPT Received *** $450.00 en Dollars Thank You I 0 NEXT VISIT Data Time 0 01 •-•-• cr 61 I I Duration w. r Provider Location 0- 20.cs,.._44.jt-9a-t C---) ; • CO-in liter\ tr.a.. or k-1 /40--b Ce.2%-\ • tNA vo k-or owe cre.e O A "A -2.\'b \940-H uer szynnritare), EFTA00317139