Inpatient 6/25-6/28 for Jessica charges submitted 12778.04 benefits paid 6230.60 our cost 0
Jessica procedure 6/25 3500.00 2927.00 cost 0
Jessica surgery 6/25 250.00 133.00 0
I/P physician 6/26 160.00 49.00 0
anesthesia 6/25 800.00 545.00 0
neonatologist 6/26 258.00 204.00 0
neonatologist 6/25 548.00 449.00 0
neonatologist 6/27 258.00 204.00 0
neonatologist 6/28 258.00 204.00 0
neonatologist 6/29 258.00 204.00 0
neonatologist 6/30 258.00 204.00 0
neonatologist 7/01 258.00 186.00 0
neonatologist 7/02 258.00 186.00 0
neonatologist 7/03 258.00 186.00 0
neonatologist 7/04 258.00 186.00 0
neonatologist 7/05 258.00 186.00 0
neonatologist 7/06 258.00 186.00 0
neonatologist 7/07 258.00 186.00 0
neonatologist 7/08 258.00 186.00 0
neonatologist 7/09 258.00 186.00 0
neonatologist 7/10 258.00 186.00 0
neonatologist 7/11 258.00 186.00 0
neonatologist 7/12 258.00 186.00 0
neonatologist 7/13 258.00 186.00 0
neonatologist 7/14 258.00 186.00 0
neonatologist 7/15 258.00 186.00 0
neonatologist 7/16 258.00 186.00 0
neonatologist 7/17 258.00 186.00 0
neonatologist 7/18 258.00 186.00 0
neonatologist 7/19 258.00 186.00 0
hospital 6/25-6/30 71321.24 0 71321.24
Med Equip 9/23 425.00 323.80 0
Med Supplies 9/21 28.70 28.70 0
Med Equip 8/23 425.00 323.80 0
outpatient for Jessica 5/22 565.48 373.22 0
xray 6/26 28.00 16.00 0
xray 6/29 100.00 57.00 0
inpatient 7/15-7/24 13905.00 3900.21 0
inpatient6/25-6/30 9270.00 2600.16 0
inpatient 7/01-7/14 48146.24 6067.04 0
xray 7/13 224.00 131.00 0
neonatologist 7/20 258.00 186.00 0
neonatologist 7/21 258.00 186.00 0
neonatoloigst 7/22 258.00 186.00 0
supplies 7/23 21.00 21.00 0
supplies 7/23 21.00 21.00 0
supplies 7/23 36.40 36.40 0
med equip 7/23 425.00 323.80 0
neonatologist 7/23 258.00 186.00 0
neonatologist 7/24 168.00 136.00 0
professional 7/9 235.00 120.00 0
professional 7/9 75.00 39.00 0
professional 7/9 150.00 7.50 0
med equip 10.23 425.00 323.80 0
lab for Jessica 6/2 433.05 209. 0
outpatient for Jessica 6/2 493.91 325.98 0
