EMPIRE MEDICARE SERVICES
AREA 99 NEW JERSEY
2005 FEE SCHEDULE

 

# PROCEDURE
CODE		 MOD PAR
FEE		 NONPAR
FEE		 LIMITING
CHARGE
28126 332.30 315.69 363.04
28130 647.65 615.27 707.56
# 28140 505.97 480.67 552.77
28140 609.92 579.42 666.33
# 28150 318.33 302.41 347.77
28150 383.83 364.64 419.34
# 28153 273.88 260.19 299.22
28153 342.76 325.62 374.46
# 28160 305.23 289.97 333.47
28160 357.20 339.34 390.24
28171 654.59 621.86 715.14
# 28173 606.09 575.79 662.16
28173 707.50 672.13 772.95
# 28175 420.77 399.73 459.69
28175 505.29 480.03 552.03
# 28190 147.60 140.22 161.25
28190 228.31 216.89 249.42
# 28192 357.35 339.48 390.40
28192 434.68 412.95 474.89
# 28193 416.77 395.93 455.32
28193 487.76 463.37 532.88
# 28200 352.71 335.07 385.33
28200 417.79 396.90 456.44
# 28202 491.44 466.87 536.90
28202 606.38 576.06 662.47
# 28208 332.01 315.41 362.72
28208 395.82 376.03 432.43
# 28210 449.02 426.57 490.56
28210 541.56 514.48 591.65
# 28220 343.00 325.85 374.73
28220 395.82 376.03 432.43
# 28222 420.16 399.15 459.02
28222 467.07 443.72 510.28
# 28225 283.18 269.02 309.37
28225 341.49 324.42 373.08
# 28226 356.89 339.05 389.91
28226 401.26 381.20 438.38
# 28230 341.81 324.72 373.43
28230 384.06 364.86 419.59
# 28232 289.16 274.70 315.91
28232 340.29 323.28 371.77
# 28234 289.70 275.22 316.50
28234 345.48 328.21 377.44
28238 648.12 615.71 708.07
# 28238 550.51 522.98 601.43
# 28240 339.23 322.27 370.61
28240 387.82 368.43 423.69
# 28250 437.16 415.30 477.60
28250 500.12 475.11 546.38
# 28260 565.02 536.77 617.29
28260 621.22 590.16 678.68
# 28261 826.12 784.81 902.53
28261 881.47 837.40 963.01
# 28262 1,176.51 1,117.68 1,285.33
28262 1,288.06 1,223.66 1,407.21
# 28264 769.98 731.48 841.20
28264 789.00 749.55 861.98
# 28270 366.97 348.62 400.91
28270 415.99 395.19 454.47
# 28272 286.56 272.23 313.06
28272 342.76 325.62 374.46
# 28280 419.60 398.62 458.41
28280 493.97 469.27 539.66
28285 407.31 386.94 444.98
# 28285 346.46 329.14 378.51
28286 402.43 382.31 439.66
# 28286 337.36 320.49 368.56
28288 460.25 437.24 502.83
# 28288 415.88 395.09 454.35
28289 650.82 618.28 711.02
# 28289 557.02 529.17 608.55
28290 516.16 490.35 563.90
# 28290 451.51 428.93 493.27
# 28292 543.61 516.43 593.89
28292 625.16 593.90 682.99
# 28293 658.65 625.72 719.58
28293 854.72 811.98 933.78
# 28294 575.27 546.51 628.49
28294 690.21 655.70 754.06
# 28296 632.88 601.24 691.43
28296 748.66 711.23 817.91
# 28297 672.80 639.16 735.03
28297 786.47 747.15 859.22
# 28298 561.34 533.27 613.26
28298 654.73 621.99 715.29
# 28299 721.56 685.48 788.30
28299 835.65 793.87 912.95
28300 727.64 691.26 794.95
28302 717.64 681.76 784.02
# 28304 648.20 615.79 708.16
28304 741.59 704.51 810.19
28305 742.25 705.14 810.91
28306 549.26 521.80 600.07
# 28306 436.86 415.02 477.27
28307 747.35 709.98 816.48
# 28307 504.80 479.56 551.49
28308 475.66 451.88 519.66
# 28308 388.62 369.19 424.57
28309 911.40 865.83 995.70
# 28310 388.62 369.19 424.57


# 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.