Invoice HP-1206

Needs provider amendmentMissing follow-up
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Patient accountCredit available $0.00Balance owed $0.00
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Luminary Health

Luminary Health Partners, PLLC

2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Riverside Clinic · Priya Raman, NP

Invoice

HP-1206

Issued
08-23-2026
Payment
Card

Billed to

Ruth Bennett

DOB 04-11-1996
562 Meadow Lark Way, Alameda, CA 94501
(510) 555-0198 · ruth.bennett@example.com

Rendering provider

Priya Raman, NP

Riverside Clinic

DescriptionEnc.QtyUnit priceAmount

Comprehensive Evaluation

Service· HP-1001 · CPT 99204

21$185.00$185.00

Nutrition Coaching Program

Packages· HP-4002 · Needs provider review

  • Follow-up Visit (20 min)
  • Comprehensive Metabolic Panel
  • Vitamin D3 5000 IU (90 ct)— Daily for 90 days
11$129.00$129.00
Subtotal
$314.00
Discounts
−$10.00
Total due
$304.00

Linked encounters

1

07-28-2026 · Lab Review

Clinic · Dr. Alicia Chen, MD · Riverside Clinic · Self-pay · note-8740

Assessment

Healthy adult; labs normal.

Plan

No changes. Continue annual screening.

Supports:Nutrition Coaching Program
2

08-10-2026 · Annual Wellness Evaluation

Clinic · Dr. Samuel Ortiz, DO · Northgate Clinic · note-8620

Assessment

Healthy adult; hypertension borderline.

Plan

Baseline labs, blood pressure recheck in 3 months.

Supports:Comprehensive Evaluation
3

08-23-2026 · Metabolic Follow-up

Clinic · Dr. Alicia Chen, MD · Riverside Clinic · note-8488

Assessment

—

Plan

Reschedule at earliest convenience.

Supports:no items on this invoice