EMPIRE MEDICARE SERVICES
AREA 99 NEW JERSEY
2005 FEE SCHEDULE

 

# PROCEDURE
CODE		 MOD PAR
FEE		 NONPAR
FEE		 LIMITING
CHARGE
# 11421 107.45 102.08 117.39
11421 147.59 140.21 161.24
# 11422 125.73 119.44 137.36
11422 164.60 156.37 179.83
# 11423 147.56 140.18 161.21
11423 195.31 185.54 213.37
# 11424 172.23 163.62 188.16
11424 222.94 211.79 243.56
# 11426 252.24 239.63 275.57
11426 310.55 295.02 339.27
# 11440 99.92 94.92 109.16
11440 137.53 130.65 150.25
# 11441 125.86 119.57 137.51
11441 161.36 153.29 176.28
# 11442 139.40 132.43 152.29
11442 180.39 171.37 197.08
# 11443 174.14 165.43 190.24
11443 220.62 209.59 241.03
# 11444 226.09 214.79 247.01
11444 280.60 266.57 306.56
# 11446 308.43 293.01 336.96
11446 362.09 343.99 395.59
# 11450 205.08 194.83 224.05
11450 332.27 315.66 363.01
# 11451 280.83 266.79 306.81
11451 452.39 429.77 494.24
# 11462 194.54 184.81 212.53
11462 325.54 309.26 355.65
# 11463 286.74 272.40 313.26
11463 461.68 438.60 504.39
# 11470 237.48 225.61 259.45
11470 355.80 338.01 388.71
# 11471 309.66 294.18 338.31
11471 476.15 452.34 520.19
# 11600 96.11 91.30 105.00
11600 166.25 157.94 181.63
# 11601 126.65 120.32 138.37
11601 189.19 179.73 206.69
# 11602 134.60 127.87 147.05
11602 200.52 190.49 219.06
# 11603 148.08 140.68 161.78
11603 221.61 210.53 242.11
# 11604 160.34 152.32 175.17
11604 244.00 231.80 266.57
# 11606 220.65 209.62 241.06
11606 319.11 303.15 348.62
# 11620 90.55 86.02 98.92
11620 159.85 151.86 174.64
# 11621 125.92 119.62 137.56
11621 187.62 178.24 204.98
# 11622 145.96 138.66 159.46
11622 212.30 201.69 231.94
# 11623 176.61 167.78 192.95
11623 250.56 238.03 273.73
# 11624 204.89 194.65 223.85
11624 288.13 273.72 314.78
# 11626 285.65 271.37 312.08
11626 380.30 361.29 415.48
# 11640 103.59 98.41 113.17
11640 168.67 160.24 184.28
# 11641 155.36 147.59 169.73
11641 218.32 207.40 238.51
# 11642 180.95 171.90 197.69
11642 252.36 239.74 275.70
# 11643 213.75 203.06 233.52
11643 291.50 276.93 318.47
# 11644 275.00 261.25 300.44
11644 369.23 350.77 403.39
# 11646 401.97 381.87 439.15
11646 498.31 473.39 544.40
# 11719 10.37 9.85 11.33
11719 17.98 17.08 19.64
# 11720 19.11 18.15 20.87
11720 28.41 26.99 31.04
# 11721 32.66 31.03 35.68
11721 42.38 40.26 46.30
# 11730 67.70 64.32 73.97
11730 93.05 88.40 101.66
# 11732 34.26 32.55 37.43
11732 43.55 41.37 47.58
# 11740 30.79 29.25 33.64
11740 39.24 37.28 42.87
# 11750 155.09 147.34 169.44
11750 172.41 163.79 188.36
11752 244.08 231.88 266.66
11755 123.31 117.14 134.71
# 11755 89.50 85.03 97.78
11760 180.12 171.11 196.78
# 11760 144.62 137.39 158.00
11762 248.44 236.02 271.42
# 11762 225.62 214.34 246.49
11765 105.26 100.00 115.00
# 11765 62.15 59.04 67.90
11770 260.95 247.90 285.09
# 11770 177.29 168.43 193.69
11771 490.21 465.70 535.56
# 11771 391.75 372.16 427.98
# 11772 520.34 494.32 568.47
11772 623.02 591.87 680.65
# 11900 30.40 28.88 33.21


# These amounts apply when service is performed in a facility setting.

Limiting charge applies to unassigned claims by non-participating providers.

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted
by the American Medical Association.