Luminary Health
Luminary Health Partners, PLLC
2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Northgate Clinic · Dr. Samuel Ortiz, DO
Invoice
HP-1225
- Issued
- 08-06-2026
- Payment
- Cash
Billed to
Sofia Patel
DOB 09-08-1984
88 Sunrise Terrace, Berkeley, CA 94705
(510) 555-0174 · sofia.patel@example.com
Rendering provider
Dr. Samuel Ortiz, DO
Northgate Clinic
| Description | Enc. | Qty | Unit price | Amount |
|---|---|---|---|---|
Comprehensive Evaluation Service· HP-1001 · CPT 99204 | 1 | 2 | $185.00 | $370.00 |
Continuous Glucose Sensor Product· HP-3010 · CPT A4239 Sig: 30-day trial | 1 | 1 | $89.00 | $89.00 |
- Subtotal
- $459.00
- Total due
- $459.00
Linked encounters
08-06-2026 · Headache Consult
Telehealth · Dr. Alicia Chen, MD · Riverside Clinic · Insured (Zing Health) · note-8790
Assessment
Tension-type headache, likely posture and strain related.
Plan
Start magnesium glycinate nightly. Ergonomic and hydration guidance. Physical therapy referral for cervical mobility.
Follow-up
Follow-up scheduled with the treating provider.