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Cigna · Service date Oct 15, 2026 · Dr. Priya Nair
MRN MRN-PAT-GEN-18 · 74 yrs
Credentialing status unavailable for this provider.
Encounter-level place of service is the code on Box 24B of the CMS-1500. Per-line overrides appear in the Service lines table below.
| Date of service | CPT code | Modifiers | Diagnoses | Place of service | Qty | Billed | Details |
|---|---|---|---|---|---|---|---|
| Oct 15, 2026 | 73721 | — | M25.561 | 11 - Office | 1 | $1,400.00 | |
Allowed$924.00 Pri ins paym$831.60 Pri ins adj$476.00 Pat resp$92.40 Pat bal$92.40 Bal$92.40 | |||||||
| Check date | Check number | ERA ID |
|---|---|---|
| Oct 27, 2026 | CIG-520095 | era-20095 |
| Check date | Check number | Payer Claim ID |
|---|---|---|
| Oct 27, 2026 | CIG-520095 | — |
Date of service | Facility | Status | Billed |
|---|---|---|---|
Northstar Family Health - Main | Paid | $230.00 | |
Northstar Family Health - Main | In intake | $1,800.00 | |
Northstar Family Health - Main | In intake | $320.00 | |
Northstar Family Health - Main | Paid | $150.00 | |
Northstar Family Health - Main | Paid | $1,800.00 | |
Northstar Family Health - Main | ERA received | $240.00 |