Medical 0

Payment Receipt [ Receipt Number #000488

Name of Medical Saturn clinic Date 04/30/2023
Practitioner Name MARY E BACHKO, ARNP Patient Information
License Number 1174905376 Name Cheri Weeks-Claflin
Address 826 N Mullan Rd Street Address 1728 E Olympic Ave
City/state/ZIP Spokane Valley, WA 99206 City/state/ZIP Spokane WA 99207

Code Description of Services/Medicine/Products Qty Rate Line Total($)

99215 EP MDM 45-50 mins Provider : Actually 1 $204.95 $204.95

time spent 48 minutes total.

77067 Bilateral screening mammography 1 $1,237.00 $1,237.00
88175 Cytopathology exam for cervical specimen, ThinPrep 1 $23.87 $23.87

Paid in full
,,•• Cash,
.__ _Paid
N/A
_on_
05/30/2023
_ _ _ __
Subtotal
Tax Rate
Total:
$1,465.82
0.0%
$1,465.82