Luminary Health
Luminary Health Partners, PLLC
2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Lakeside Clinic · Priya Raman, NP
Invoice
HP-1202
- Issued
- 08-27-2026
- Payment
- Check
Billed to
Dana Kim
DOB 06-27-1990
1520 Mesa Verde Ct, Austin, TX 78745
(512) 555-0162 · dana.kim@example.com
Rendering provider
Priya Raman, NP
Lakeside Clinic
| Description | Enc. | Qty | Unit price | Amount |
|---|---|---|---|---|
Follow-up Visit (20 min) Follow-up· HP-1002 · CPT 99213 | 1 | 1 | $95.00 | $95.00 |
Comprehensive Evaluation Service· HP-1001 · CPT 99204 | 1 | 1 | $185.00 | $185.00 |
- Subtotal
- $280.00
- Total due
- $280.00
Linked encounters
08-27-2026 · Low Back Pain Consult
Clinic · Dr. Samuel Ortiz, DO · Northgate Clinic · Insured (Aetna) · note-8830
Assessment
Acute mechanical low back strain.
Plan
Begin physical therapy, twice weekly for four weeks. Magnesium glycinate nightly for muscle relaxation. Reassess in 4 weeks.
- Amended 08-27-2026 by Dr. Samuel Ortiz, DO: Added magnesium recommendation after pharmacy review.
Follow-up
Follow-up scheduled with the treating provider.