Spokane Regional Health District

1001 W College Ave

Spokane, WA 99201-2095
509.324.1420 | TEL
509.327.0163 | FAX
509.324.1464 | TDD
www.SRHD.org

Patient Name: BYRON CLAFLIN

MRN #: 07732321
INS: Self pay
Address: 1728 E Olympic Ave, Spokane, WA, 99207
Phone #: 5096551704

CPT CODE DOS(DATE OF SERVICE) DESCRIPTION OF SERVICE QUA(QUANTITY) TOTAL AMOUNT

G2067 3/ 19/23-3/25/ 23 Med assist tx meth wk 1 $ 2 9 4 .7 7

G2067 3/26/ 23-4/ 1/ 23 Med assist tx meth wk 1 $ 2 9 4 .7 7

G2080 3/ 27/23 Add 30 mins counsel 1 $ 3 3 .1 8

G2067 4/2/23-4/8/23 Med assist tx meth wk 1 $ 2 9 4 .7 7

G2067 4/9/23-4/15/ 23 Med assist tx meth wk 1 $ 2 9 4 .7 7

G2067 4/ 16/23-4/22/ 23 Med assist tx meth wk 1 $ 2 9 4 .7 7

G2080 4/ 20/23 Add 30 mins counsel 1 $ 3 3 .1 8

G2078 4/ 21/23 Take-home meth 1 $ 3 9 .2 9

G2067 4/ 23/23-4/29/ 23 Med assist tx meth wk 1 $ 2 9 4 .7 7

G2067 4/30/ 23-5/ 6/ 23 Med assist tx meth wk 1 $ 2 9 4 .7 7

G2067 5/7/23-5/13/ 23 Med assist tx meth wk 1 $ 2 9 4 .7 7

G2080 5/ 9/ 23 Add 30 mins counsel 1 $ 3 3 .1 8

G2067 5/ 14/23-5/20/ 23 Med assist tx meth wk 1 $ 2 9 4 .7 7

G2067 5/ 21/23-5/27/ 23 Med assist tx meth wk 1 $ 2 9 4 .7 7

May 29, 2023