Medical bills
Maria L. Santos · built from 5 documents (4 bills + the EOB) · every row links to its pages
- Total billed
- $16,910.00
- 5 providers
- Bills in file
- $15,430.00
- 4 providers
- Missing
- $1,480.00
- 1 provider, no bill yet
| Provider · source | Date of service | Billed | Allowed | Plan paid | Patient owes | Status |
|---|---|---|---|---|---|---|
Bayview Emergency Medical Services Ambulance transport | 03/12/2026 | $1,150.00 | $620.00 | $0.00 | $620.00 | In file |
St. Anselm Regional Medical Center Emergency room, CT, labs | 03/12/2026 | $8,420.00 | $3,980.00 | $2,480.00 | $1,500.00 | In file |
Lakeside Radiology Associates P.A. CT reads, cervical + lumbar Bill: not receivedEOBp. 2 On the EOB, no bill in file. | 03/12/2026 | $1,480.00 | $710.00 | $568.00 | $142.00 | Missing |
Harbor Imaging Center MRI, lumbar + cervical | 03/28/2026 | $3,100.00 | $1,450.00 | $1,160.00 | $290.00 | In file |
Coastal Physical Therapy & Rehab Physical therapy, 12 visits | 04/02 – 05/12/2026 | $2,760.00 | $1,320.00 | $1,056.00 | $264.00 | In file |
| Total | $16,910.00 | $8,080.00 | $5,264.00 | $2,816.00 |
Billed: $15,430.00 in file + $1,480.00 missing. Allowed, plan paid and patient owes come from the Valley Crest EOB; all totals match its summary on page 1.