EMPIRE MEDICARE SERVICES
AREA 99 NEW JERSEY
2005 FEE SCHEDULE

 

# PROCEDURE
CODE		 MOD PAR
FEE		 NONPAR
FEE		 LIMITING
CHARGE
30120 499.93 474.93 546.17
30124 283.47 269.30 309.70
30125 656.26 623.45 716.97
30130 380.32 361.30 415.50
30140 409.11 388.65 446.95
30150 856.88 814.04 936.15
30160 840.72 798.68 918.48
# 30200 64.11 60.90 70.04
30200 101.29 96.23 110.66
# 30210 101.08 96.03 110.43
30210 134.46 127.74 146.90
# 30220 129.91 123.41 141.92
30220 244.00 231.80 266.57
# 30300 124.49 118.27 136.01
30300 239.43 227.46 261.58
30310 214.21 203.50 234.03
30320 488.93 464.48 534.15
30400 1,078.07 1,024.17 1,177.80
30410 1,337.06 1,270.21 1,460.74
30420 1,433.33 1,361.66 1,565.91
30430 987.59 938.21 1,078.94
30435 1,320.50 1,254.48 1,442.65
30450 1,727.20 1,640.84 1,886.97
30460 848.66 806.23 927.16
30462 1,714.99 1,629.24 1,873.63
30465 1,000.74 950.70 1,093.31
30520 522.15 496.04 570.45
30540 720.67 684.64 787.34
30545 1,010.81 960.27 1,104.31
30560 254.72 241.98 278.28
# 30560 143.16 136.00 156.40
30580 623.41 592.24 681.08
# 30580 539.75 512.76 589.67
30600 578.80 549.86 632.34
# 30600 473.16 449.50 516.93
30620 628.14 596.73 686.24
30630 637.58 605.70 696.56
30801 220.63 209.60 241.04
# 30801 127.25 120.89 139.02
# 30802 185.69 176.41 202.87
30802 280.77 266.73 306.74
30901 109.03 103.58 119.12
# 30901 65.08 61.83 71.10
30903 179.77 170.78 196.40
# 30903 86.38 82.06 94.37
30905 231.93 220.33 253.38
# 30905 115.73 109.94 126.43
30906 267.94 254.54 292.72
# 30906 154.27 146.56 168.54
30915 586.74 557.40 641.01
30920 794.08 754.38 867.54
30930 122.35 116.23 133.66
31000 168.48 160.06 184.07
# 31000 107.63 102.25 117.59
31002 217.80 206.91 237.95
# 31020 345.01 327.76 376.92
31020 486.56 462.23 531.56
31030 739.37 702.40 807.76
# 31030 534.85 508.11 584.33
31032 585.19 555.93 639.32
31040 815.75 774.96 891.20
31050 494.78 470.04 540.55
31051 650.55 618.02 710.72
31070 432.97 411.32 473.02
31075 799.89 759.90 873.89
31080 1,061.71 1,008.62 1,159.91
31081 1,181.36 1,122.29 1,290.63
31084 1,146.19 1,088.88 1,252.21
31085 1,208.57 1,148.14 1,320.36
31086 1,105.47 1,050.20 1,207.73
31087 1,097.95 1,043.05 1,199.51
31090 938.37 891.45 1,025.17
31200 594.98 565.23 650.01
31201 745.95 708.65 814.95
31205 928.33 881.91 1,014.20
31225 1,569.14 1,490.68 1,714.28
31230 1,745.04 1,657.79 1,906.46
# 31231 83.69 79.51 91.44
31231 189.33 179.86 206.84
# 31233 155.50 147.73 169.89
31233 274.67 260.94 300.08
# 31235 185.92 176.62 203.11
31235 320.71 304.67 350.37
# 31237 206.77 196.43 225.89
31237 346.63 329.30 378.70
# 31238 226.26 214.95 247.19
31238 358.95 341.00 392.15
31239 702.09 666.99 767.04
31240 184.43 175.21 201.49
31254 319.20 303.24 348.73
31255 473.46 449.79 517.26
31256 230.87 219.33 252.23
31267 373.28 354.62 407.81
31276 596.98 567.13 652.20
31287 271.42 257.85 296.53
31288 315.13 299.37 344.28
31290 1,239.82 1,177.83 1,354.50
31291 1,301.50 1,236.43 1,421.89
31292 1,071.67 1,018.09 1,170.80
31293 1,164.82 1,106.58 1,272.57


# 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.