Procedure Code Description Rate - Rhode Island

rear wheel assembly complete, with pneumatic tire, spokes or molder, each $168.21 k0071: front caster assembly complete, with pneumatic tire, each $100.33

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Transcription of Procedure Code Description Rate - Rhode Island

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CARR CDCARRIER NAME PHONE NUMBER STREET CITY …

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carr cdcarrier name phone number street city state zip code 0e2 union labor life (877) 800-2956 161 forbes road suite 204 braintree ma 02184 0e3 union labor life ins. co. (877) 800-2956 260 park ave new york ny 10010 001 blue cross/blue shield of (800) 637-3718 444 westminister st providence ri 02901

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pr0029 v1.5 01/24/2018 . cms 1500 (02/12) claim form instructions . field numbe r field name instructions 1 a . insured’s id number

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107 Processed according to contract/plan provisions. 484 THESE SERVICES ARE COVERED IN FEE PAID FOR TOTAL OB CARE Obstetrics Unit 107 Processed according to contract/plan provisions. 556 PAYMENT FOR SERVICE INCLUDED IN PER DIEM RATE Billing Provider

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