Invoice HP-1216

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Luminary Health

Luminary Health Partners, PLLC

2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Northgate Clinic · Dr. Alicia Chen, MD

Invoice

HP-1216

Issued
08-14-2026
Payment
Card

Billed to

Dana Kim

DOB 06-27-1990
1520 Mesa Verde Ct, Austin, TX 78745
(512) 555-0162 · dana.kim@example.com

Rendering provider

Dr. Alicia Chen, MD

Northgate Clinic

DescriptionEnc.QtyUnit priceAmount

Comprehensive Evaluation

Service· HP-1001 · CPT 99204 · Recurring every 90 days

11$185.00$185.00

Physical Therapy Session

Service· HP-1020 · CPT 97110 · Needs provider review

11$110.00$110.00
Subtotal
$295.00
Total due
$295.00

Linked encounters

1

08-01-2026 · Metabolic Follow-up

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

Assessment

—

Plan

Reschedule at earliest convenience.

Supports:Comprehensive EvaluationPhysical Therapy Session
2

08-14-2026 · Lab Review

Clinic · Dr. Alicia Chen, MD · Riverside Clinic · note-8712

Assessment

Prediabetes, stable.

Plan

Continue lifestyle measures. Repeat labs in 3 months.

Supports:no items on this invoice

Recurring billing

  • Comprehensive Evaluation · every 90 days · membership

Follow-up

Follow-up scheduled with the treating provider.