| Jurisdiction A DME MAC | ||||||||||||||
| 4th Quarter 2005 DMEPOS/PEN Fee Schedule Updates | ||||||||||||||
| 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 | |
| L6694 | $632.69 | $563.43 | $563.43 | $632.69 | $563.43 | $632.69 | $632.69 | $535.88 | $535.88 | $563.43 | $632.69 | $632.69 | ||
| L6695 | $527.21 | $469.51 | $469.51 | $527.21 | $469.51 | $527.21 | $527.21 | $446.56 | $446.56 | $469.51 | $527.21 | $527.21 | ||
| L6696 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | ||
| L6697 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | $1,035.59 | ||
| L6698 | $398.91 | $398.91 | $398.91 | $398.91 | $398.91 | $398.91 | $398.91 | $398.91 | $398.91 | $398.91 | $398.91 | $398.91 | ||