Patient payment portal

Stripe-powered statements with payment plans and good-faith estimates.

Authored byQuiet Finch — Developer 8821@quiet-finch-8821

Vibe-coded in JetBridge AI · clone in one click on launch day

Lila Hamasaki · MRN 88-771-2204

Office visit · Dr. Adeyemi

Apr 15, 2026 · STMT-2026-04

$312.00 → $188.40 allowed

$37.70

Lab panel · CMP, Lipid, A1C

Mar 22, 2026 · STMT-2026-03

$184.00 → $96.50 allowed

$19.30

Telehealth f/u

Feb 18, 2026 · STMT-2026-02

$150.00 → $88.00 allowed

$17.60

MRI L knee w/o contrast

Jan 20, 2026 · STMT-2026-01

$1850.00 → $720.00 allowed

$144.00

Selected balance

$57.00

Good-faith estimates

Pre-service price transparency · No Surprises Act

Office visit · 99213$28–$52

Wellness exam · 99396Covered preventive

Knee MRI w/o contrast · 73721$120–$285

Insurance summary

PlanBCBS IL · PPO Bronze

Deductible YTD$1,840 / $3,000

Out-of-pocket YTD$2,182 / $7,500

Copay (PCP)$30

Choose payment plan

Card details

•••• •••• •••• 4242Visa · exp 09/28

PCI DSS · processed via Stripe

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