| Jurisdiction A DME MAC | ||||||||||||||||||||
| 1st Quarter 2006 DMEPOS/PEN Fee Schedule Updates | ||||||||||||||||||||
| Revised October 1, 2006 | ||||||||||||||||||||
| Inclusion of a fee schedule amount for an item does not necessarily indicate coverage | ||||||||||||||||||||
| MOD1 | MOD2 | CT | DC | DE | MA | MD | ME | NH | NJ | NY | PA | RI | VT | |||||||
| E1238 | NU | $1,638.73 | $1,638.73 | $1,638.73 | $1,638.73 | $1,638.73 | $1,638.73 | $1,638.73 | $1,638.73 | $1,638.73 | $1,638.73 | $1,638.73 | $1,638.73 | |||||||
| E1238 | RR | $163.87 | $163.87 | $163.87 | $163.87 | $163.87 | $163.87 | $163.87 | $163.87 | $163.87 | $163.87 | $163.87 | $163.87 | |||||||
| E1238 | UE | $1,229.05 | $1,229.05 | $1,229.05 | $1,229.05 | $1,229.05 | $1,229.05 | $1,229.05 | $1,229.05 | $1,229.05 | $1,229.05 | $1,229.05 | $1,229.05 | |||||||
| E2620 | NU | $547.70 | $547.70 | $547.70 | $547.70 | $547.70 | $547.70 | $547.70 | $547.70 | $547.70 | $547.70 | $547.70 | $547.70 | |||||||
| E2620 | RR | $54.77 | $54.77 | $54.77 | $54.77 | $54.77 | $54.77 | $54.77 | $54.77 | $54.77 | $54.77 | $54.77 | $54.77 | |||||||
| E2620 | UE | $410.79 | $410.79 | $410.79 | $410.79 | $410.79 | $410.79 | $410.79 | $410.79 | $410.79 | $410.79 | $410.79 | $410.79 | |||||||
| E2621 | NU | $574.76 | $574.76 | $574.76 | $574.76 | $574.76 | $574.76 | $574.76 | $574.76 | $574.76 | $574.76 | $574.76 | $574.76 | |||||||
| E2621 | RR | $57.47 | $57.47 | $57.47 | $57.47 | $57.47 | $57.47 | $57.47 | $57.47 | $57.47 | $57.47 | $57.47 | $57.47 | |||||||
| E2621 | UE | $431.08 | $431.08 | $431.08 | $431.08 | $431.08 | $431.08 | $431.08 | $431.08 | $431.08 | $431.08 | $431.08 | $431.08 | |||||||
| K0738 | RR | $32.07 | $32.07 | $32.07 | $32.07 | $32.07 | $32.07 | $32.07 | $32.07 | $32.07 | $32.07 | $32.80 | $32.07 | |||||||
| L2232 | $78.20 | $78.20 | $78.20 | $78.20 | $78.20 | $78.20 | $78.20 | $78.20 | $78.20 | $78.20 | $78.20 | $78.20 | ||||||||