1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 1 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ D0416 9.26 8.80 10.12 G0181 157.77 149.88 172.36 D0421 9.26 8.80 10.12 G0182 168.29 159.88 183.86 D0431 9.26 8.80 10.12 G0186 366.43 348.11 400.33 D0475 23.25 22.09 25.40 G0202 193.15 183.49 211.01 D0476 108.93 103.48 119.00 G0202 TC 150.84 143.30 164.80 D0477 81.28 77.22 88.80 G0202 26 42.31 40.19 46.22 D0478 136.31 129.49 148.91 G0204 200.81 190.77 219.39 D0479 170.78 162.24 186.58 G0204 TC 148.50 141.08 162.24 D0481 595.96 566.16 651.08 G0204 26 52.31 49.69 57.14 D0482 125.22 118.96 136.80 G0206 162.50 154.38 177.54 D0483 107.59 102.21 117.54 G0206 TC 120.19 114.18 131.31 D0484 98.59 93.66 107.71 G0206 26 42.31 40.19 46.22 # D0484 95.51 90.73 104.34 G0237 27.98 26.58 30.57 D0485 157.42 149.55 171.98 G0238 29.15 27.69 31.84 D7288 191.92 182.32 209.67 G0239 19.79 18.80 21.62 # D7288 125.37 119.10 136.97 G0245 82.53 78.40 90.16 D7321 410.77 390.23 448.76 # G0245 54.47 51.75 59.51 # D7321 315.78 299.99 344.99 G0246 50.15 47.64 54.79 D7511 338.34 321.42 369.63 # G0246 27.93 26.53 30.51 # D7511 265.53 252.25 290.09 G0247 50.99 48.44 55.71 D7521 197.47 187.60 215.74 # G0247 32.86 31.22 35.90 # D7521 122.95 116.80 134.32 G0248 387.94 368.54 423.82 G0101 48.98 46.53 53.51 G0249 232.40 220.78 253.90 # G0101 28.51 27.08 31.14 G0250 10.99 10.44 12.01 G0102 29.88 28.39 32.65 G0268 61.84 58.75 67.56 # G0102 10.58 10.05 11.56 # G0268 39.03 37.08 42.64 G0104 173.86 165.17 189.95 G0270 27.73 26.34 30.29 # G0104 69.78 66.29 76.23 G0271 10.77 10.23 11.76 G0105 515.84 490.05 563.56 G0275 16.14 15.33 17.63 # G0105 241.59 229.51 263.94 G0278 16.14 15.33 17.63 G0105 53 173.86 165.17 189.95 G0281 13.91 13.21 15.19 # G0105 53 69.78 66.29 76.23 G0283 13.91 13.21 15.19 G0106 193.66 183.98 211.58 G0288 626.62 595.29 684.58 G0106 TC 134.19 127.48 146.60 G0289 112.65 107.02 123.07 G0106 26 59.47 56.50 64.98 G0308 1,022.70 971.57 1,117.31 G0108 48.78 46.34 53.29 G0309 851.45 808.88 930.21 G0109 28.32 26.90 30.94 G0310 681.28 647.22 744.30 G0117 60.43 57.41 66.02 G0311 675.85 642.06 738.37 # G0117 29.43 27.96 32.15 G0312 562.75 534.61 614.80 G0118 38.07 36.17 41.60 G0313 450.34 427.82 491.99 # G0118 10.58 10.05 11.56 G0314 598.33 568.41 653.67 G0120 193.66 183.98 211.58 G0315 498.05 473.15 544.12 G0120 TC 134.19 127.48 146.60 G0316 398.44 378.52 435.30 G0120 26 59.47 56.50 64.98 G0317 376.49 357.67 411.32 G0121 515.84 490.05 563.56 G0318 313.54 297.86 342.54 # G0121 241.59 229.51 263.94 G0319 250.58 238.05 273.76 G0121 53 173.86 165.17 189.95 G0320 851.45 808.88 930.21 # G0121 53 69.78 66.29 76.23 G0321 562.75 534.61 614.80 G0124 26.14 24.83 28.55 G0322 498.05 473.15 544.12 G0127 21.69 20.61 23.70 G0323 313.54 297.86 342.54 # G0127 11.17 10.61 12.20 G0324 28.34 26.92 30.96 G0128 5.21 4.95 5.69 G0325 16.50 15.68 18.03 G0130 61.19 58.13 66.85 G0326 18.69 17.76 20.42 G0130 TC 48.01 45.61 52.45 G0327 10.55 10.02 11.52 G0130 26 13.18 12.52 14.40 G0329 10.84 10.30 11.85 G0141 26.14 24.83 28.55 # G0329 3.83 3.64 4.19 G0166 212.40 201.78 232.05 G0332 111.69 106.11 122.03 # G0166 4.81 4.57 5.26 G0341 628.47 597.05 686.61 G0168 132.26 125.65 144.50 # G0341 444.28 422.07 485.38 # G0168 31.68 30.10 34.62 G0342 825.37 784.10 901.72 G0179 78.80 74.86 86.09 G0343 1,361.64 1,293.56 1,487.59 G0180 101.33 96.26 110.70 G0344 122.37 116.25 133.69 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 2 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # G0344 84.37 80.15 92.17 11006 822.33 781.21 898.39 G0364 15.60 14.82 17.04 11008 334.61 317.88 365.56 # G0364 10.92 10.37 11.93 11010 587.50 558.13 641.85 G0365 250.11 237.60 273.24 # 11010 338.39 321.47 369.69 G0365 TC 234.31 222.59 255.98 11011 695.04 660.29 759.33 G0365 26 15.80 15.01 17.26 # 11011 354.12 336.41 386.87 G0366 37.39 35.52 40.85 11012 1,014.49 963.77 1,108.34 G0367 26.81 25.47 29.29 # 11012 529.73 503.24 578.73 G0368 10.58 10.05 11.56 11040 51.97 49.37 56.78 G0372 29.88 28.39 32.65 # 11040 33.85 32.16 36.98 # G0372 10.58 10.05 11.56 11041 74.00 70.30 80.85 G0375 15.15 14.39 16.55 # 11041 54.70 51.97 59.77 G0376 30.05 28.55 32.83 11042 104.92 99.67 114.62 # G0376 29.47 28.00 32.20 # 11042 73.93 70.23 80.76 M0064 34.99 33.24 38.23 11043 301.74 286.65 329.65 # M0064 22.13 21.02 24.17 # 11043 255.54 242.76 279.17 P3001 26.14 24.83 28.55 11044 394.34 374.62 430.81 Q0035 33.88 32.19 37.02 # 11044 353.40 335.73 386.09 Q0035 TC 23.30 22.14 25.46 11055 51.25 48.69 55.99 Q0035 26 10.58 10.05 11.56 # 11055 28.45 27.03 31.08 Q0091 54.54 51.81 59.58 11056 63.66 60.48 69.55 # Q0091 23.54 22.36 25.71 # 11056 39.68 37.70 43.36 Q0092 18.96 18.01 20.71 11057 77.47 73.60 84.64 R0070 174.06 165.36 190.16 # 11057 51.75 49.16 56.53 R0075 174.06 165.36 190.16 11100 106.37 101.05 116.21 0016T 366.43 348.11 400.33 # 11100 54.91 52.16 59.98 0024T 708.26 672.85 773.78 11101 36.26 34.45 39.62 0030T 26.18 24.87 28.60 # 11101 28.07 26.67 30.67 0067T 607.65 577.27 663.86 11200 92.73 88.09 101.30 0067T TC 535.18 508.42 584.68 # 11200 76.36 72.54 83.42 0067T 26 72.47 68.85 79.18 11201 21.50 20.43 23.49 0073T 1,059.87 1,006.88 1,157.91 # 11201 19.16 18.20 20.93 10021 179.79 170.80 196.42 11300 79.12 75.16 86.43 # 10021 85.06 80.81 92.93 # 11300 33.51 31.83 36.60 10022 202.10 192.00 220.80 11301 100.04 95.04 109.30 # 10022 77.55 73.67 84.72 # 11301 57.35 54.48 62.65 10040 107.70 102.32 117.67 11302 119.43 113.46 130.48 # 10040 94.83 90.09 103.60 # 11302 70.31 66.79 76.81 10060 120.72 114.68 131.88 11303 143.93 136.73 157.24 # 10060 104.34 99.12 113.99 # 11303 81.95 77.85 89.53 10061 209.84 199.35 229.25 11305 78.35 74.43 85.59 # 10061 190.54 181.01 208.16 # 11305 44.43 42.21 48.54 10080 231.57 219.99 252.99 11306 105.82 100.53 115.61 # 10080 114.62 108.89 125.22 # 11306 66.06 62.76 72.17 10081 342.92 325.77 374.64 11307 122.96 116.81 134.33 # 10081 192.05 182.45 209.82 # 11307 76.18 72.37 83.23 10120 179.45 170.48 196.05 11308 144.64 137.41 158.02 # 10120 108.69 103.26 118.75 # 11308 94.35 89.63 103.07 10121 322.04 305.94 351.83 11310 95.22 90.46 104.03 # 10121 220.87 209.83 241.30 # 11310 49.02 46.57 53.56 10140 170.24 161.73 185.99 11311 115.34 109.57 126.01 # 10140 141.58 134.50 154.68 # 11311 72.07 68.47 78.74 10160 145.22 137.96 158.65 11312 132.72 126.08 144.99 # 10160 114.81 109.07 125.43 # 11312 81.85 77.76 89.42 10180 273.86 260.17 299.20 11313 173.39 164.72 189.43 # 10180 215.39 204.62 235.31 # 11313 109.65 104.17 119.80 11000 59.75 56.76 65.27 11400 152.58 144.95 166.69 # 11000 38.69 36.76 42.27 # 11400 87.08 82.73 95.14 11001 26.49 25.17 28.95 11401 172.34 163.72 188.28 # 11001 19.47 18.50 21.28 # 11401 111.52 105.94 121.83 11004 659.34 626.37 720.33 11402 194.27 184.56 212.24 11005 902.34 857.22 985.80 # 11402 127.02 120.67 138.77 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 3 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 11403 216.44 205.62 236.46 11624 348.87 331.43 381.14 # 11403 153.29 145.63 167.47 # 11624 233.67 221.99 255.29 11404 246.40 234.08 269.19 11626 454.77 432.03 496.83 # 11404 169.80 161.31 185.51 # 11626 323.78 307.59 353.73 11406 298.29 283.38 325.89 11640 212.49 201.87 232.15 # 11406 215.25 204.49 235.16 # 11640 121.85 115.76 133.12 11420 145.09 137.84 158.52 11641 267.90 254.51 292.69 # 11420 95.97 91.17 104.85 # 11641 180.19 171.18 196.86 11421 181.30 172.24 198.08 11642 308.13 292.72 336.63 # 11421 125.16 118.90 136.74 # 11642 208.73 198.29 228.03 11422 201.58 191.50 220.23 11643 353.74 336.05 386.46 # 11422 147.20 139.84 160.82 # 11643 246.14 233.83 268.90 11423 237.13 225.27 259.06 11644 444.87 422.63 486.02 # 11423 170.47 161.95 186.24 # 11644 314.47 298.75 343.56 11424 268.10 254.70 292.91 11646 591.07 561.52 645.75 # 11424 197.35 187.48 215.60 # 11646 457.16 434.30 499.45 11426 366.38 348.06 400.27 11719 21.94 20.84 23.97 # 11426 285.69 271.41 312.12 # 11719 11.42 10.85 12.48 11440 173.79 165.10 189.87 11720 33.72 32.03 36.83 # 11440 121.16 115.10 132.37 # 11720 20.86 19.82 22.79 11441 199.49 189.52 217.95 11721 49.15 46.69 53.69 # 11441 149.79 142.30 163.65 # 11721 35.70 33.92 39.01 11442 222.16 211.05 242.71 11730 109.08 103.63 119.17 # 11442 164.85 156.61 180.10 # 11730 73.99 70.29 80.83 11443 268.17 254.76 292.97 11732 50.35 47.83 55.00 # 11443 203.85 193.66 222.71 # 11732 37.49 35.62 40.96 11444 337.04 320.19 368.22 11740 48.01 45.61 52.45 # 11444 261.60 248.52 285.80 # 11740 36.32 34.50 39.68 11446 427.40 406.03 466.93 11750 207.04 196.69 226.19 # 11446 353.14 335.48 385.80 # 11750 183.06 173.91 200.00 11450 412.77 392.13 450.95 11752 291.32 276.75 318.26 # 11450 236.76 224.92 258.66 11755 147.89 140.50 161.58 11451 558.46 530.54 610.12 # 11755 101.10 96.05 110.46 # 11451 320.46 304.44 350.11 11760 222.44 211.32 243.02 11462 408.12 387.71 445.87 # 11760 173.32 164.65 189.35 # 11462 226.85 215.51 247.84 11762 293.97 279.27 321.16 11463 571.57 542.99 624.44 # 11762 262.40 249.28 286.67 # 11463 328.90 312.46 359.33 11765 134.36 127.64 146.79 11470 436.90 415.06 477.32 # 11765 74.13 70.42 80.98 # 11470 273.17 259.51 298.44 11770 317.07 301.22 346.40 11471 584.02 554.82 638.04 # 11770 200.70 190.67 219.27 # 11471 353.04 335.39 385.70 11771 579.41 550.44 633.01 11600 209.47 199.00 228.85 # 11771 442.58 420.45 483.52 # 11600 111.81 106.22 122.15 11772 741.69 704.61 810.30 11601 233.74 222.05 255.36 # 11772 599.01 569.06 654.42 # 11601 146.61 139.28 160.17 11900 59.39 56.42 64.88 11602 246.78 234.44 269.61 # 11900 33.66 31.98 36.78 # 11602 154.97 147.22 169.30 11901 71.47 67.90 78.09 11603 272.03 258.43 297.19 # 11901 53.34 50.67 58.27 # 11603 169.70 161.22 185.40 11920 287.54 273.16 314.13 11604 298.99 284.04 326.65 # 11920 134.34 127.62 146.76 # 11604 182.63 173.50 199.53 11921 316.83 300.99 346.14 11606 384.26 365.05 419.81 # 11921 158.95 151.00 173.65 # 11606 248.02 235.62 270.96 11922 88.07 83.67 96.22 11620 202.06 191.96 220.75 # 11922 36.03 34.23 39.36 # 11620 105.58 100.30 115.35 11950 101.89 96.80 111.32 11621 232.13 220.52 253.60 # 11950 58.03 55.13 63.40 # 11621 146.17 138.86 159.69 11951 137.65 130.77 150.39 11622 261.09 248.04 285.25 # 11951 80.34 76.32 87.77 # 11622 168.69 160.26 184.30 11952 180.60 171.57 197.31 11623 305.09 289.84 333.32 # 11952 111.60 106.02 121.92 # 11623 202.17 192.06 220.87 11954 223.75 212.56 244.44 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 4 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11954 133.11 126.45 145.42 # 12045 289.85 275.36 316.66 11960 1,005.99 955.69 1,099.04 12046 564.91 536.66 617.16 11970 668.74 635.30 730.60 # 12046 345.04 327.79 376.96 11971 627.93 596.53 686.01 12047 572.61 543.98 625.58 # 11971 315.67 299.89 344.87 # 12047 381.39 362.32 416.67 11976 177.26 168.40 193.66 12051 295.96 281.16 323.33 # 11976 116.45 110.63 127.22 # 12051 188.95 179.50 206.43 11980 125.81 119.52 137.45 12052 304.35 289.13 332.50 # 11980 94.24 89.53 102.96 # 12052 199.09 189.14 217.51 11981 161.82 153.73 176.79 12053 321.06 305.01 350.76 # 11981 102.18 97.07 111.63 # 12053 220.48 209.46 240.88 11982 189.73 180.24 207.28 12054 354.75 337.01 387.56 # 11982 124.23 118.02 135.72 # 12054 241.31 229.24 263.63 11983 272.15 258.54 297.32 12055 451.22 428.66 492.96 # 11983 224.20 212.99 244.94 # 12055 313.21 297.55 342.18 12001 188.36 178.94 205.78 12056 620.53 589.50 677.93 # 12001 117.02 111.17 127.85 # 12056 403.59 383.41 440.92 12002 198.79 188.85 217.18 12057 612.46 581.84 669.12 # 12002 131.54 124.96 143.70 # 12057 472.70 449.07 516.43 12004 231.41 219.84 252.82 13100 369.16 350.70 403.31 # 12004 154.23 146.52 168.50 # 13100 266.83 253.49 291.51 12005 287.04 272.69 313.59 13101 436.57 414.74 476.95 # 12005 191.72 182.13 209.45 # 13101 320.78 304.74 350.45 12006 354.48 336.76 387.27 13102 121.44 115.37 132.68 # 12006 243.96 231.76 266.52 # 13102 86.35 82.03 94.33 12007 400.17 380.16 437.18 13120 381.65 362.57 416.96 # 12007 282.63 268.50 308.78 # 13120 276.40 262.58 301.97 12011 199.79 189.80 218.27 13121 463.90 440.71 506.82 # 12011 120.26 114.25 131.39 # 13121 343.44 326.27 375.21 12013 217.71 206.82 237.84 13122 149.85 142.36 163.71 # 12013 138.76 131.82 151.59 # 13122 98.39 93.47 107.49 12014 255.36 242.59 278.98 13131 413.80 393.11 452.08 # 12014 166.48 158.16 181.88 # 13131 315.56 299.78 344.75 12015 318.92 302.97 348.42 13132 592.69 563.06 647.52 # 12015 208.40 197.98 227.68 # 13132 490.36 465.84 535.72 12016 374.77 356.03 409.43 13133 189.49 180.02 207.02 # 12016 255.48 242.71 279.12 # 13133 152.65 145.02 166.77 12017 311.50 295.93 340.32 13150 446.40 424.08 487.69 12018 369.69 351.21 403.89 # 13150 323.02 306.87 352.90 12020 336.61 319.78 367.75 13151 467.28 443.92 510.51 # 12020 225.51 214.23 246.36 # 13151 370.21 351.70 404.46 12021 186.85 177.51 204.14 13152 617.53 586.65 674.65 # 12021 162.29 154.18 177.31 # 13152 500.58 475.55 546.88 12031 224.47 213.25 245.24 13153 214.97 204.22 234.85 # 12031 146.70 139.37 160.28 # 13153 168.19 159.78 183.75 12032 328.30 311.89 358.67 13160 878.04 834.14 959.26 # 12032 208.43 198.01 227.71 14000 710.97 675.42 776.73 12034 310.59 295.06 339.32 # 14000 571.21 542.65 624.05 # 12034 208.26 197.85 227.53 14001 912.09 866.49 996.46 12035 451.67 429.09 493.45 # 14001 774.67 735.94 846.33 # 12035 273.32 259.65 298.60 14020 784.76 745.52 857.35 12036 501.57 476.49 547.96 # 14020 663.13 629.97 724.47 # 12036 324.97 308.72 355.03 14021 1,008.65 958.22 1,101.95 12037 560.77 532.73 612.64 # 14021 908.65 863.22 992.70 # 12037 377.15 358.29 412.03 14040 847.38 805.01 925.76 12041 249.01 236.56 272.04 # 14040 753.24 715.58 822.92 # 12041 165.97 157.67 181.32 14041 1,099.79 1,044.80 1,201.52 12042 305.48 290.21 333.74 # 14041 987.52 938.14 1,078.86 # 12042 199.64 189.66 218.11 14060 873.00 829.35 953.75 12044 321.09 305.04 350.80 # 14060 793.48 753.81 866.88 # 12044 226.36 215.04 247.30 14061 1,191.73 1,132.14 1,301.96 12045 464.69 441.46 507.68 # 14061 1,068.93 1,015.48 1,167.80 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 5 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 14300 1,152.82 1,095.18 1,259.46 # 15221 84.50 80.28 92.32 # 14300 1,038.21 986.30 1,134.25 15240 983.65 934.47 1,074.64 14350 837.39 795.52 914.85 # 15240 851.50 808.93 930.27 15000 395.81 376.02 432.42 15241 223.66 212.48 244.35 # 15000 301.67 286.59 329.58 # 15241 133.61 126.93 145.97 15001 122.57 116.44 133.91 15260 1,019.14 968.18 1,113.41 # 15001 67.60 64.22 73.85 # 15260 923.24 877.08 1,008.64 15040 353.50 335.83 386.20 15261 252.65 240.02 276.02 # 15040 152.34 144.72 166.43 # 15261 176.63 167.80 192.97 15050 591.64 562.06 646.37 15300 360.08 342.08 393.39 # 15050 485.79 461.50 530.73 # 15300 303.36 288.19 331.42 15100 1,132.69 1,076.06 1,237.47 15301 71.11 67.55 77.68 # 15100 853.18 810.52 932.10 # 15301 67.02 63.67 73.22 15101 293.72 279.03 320.88 15320 415.38 394.61 453.80 # 15101 143.43 136.26 156.70 # 15320 351.64 334.06 384.17 15110 1,039.64 987.66 1,135.81 15321 105.79 100.50 115.58 # 15110 824.45 783.23 900.71 # 15321 99.94 94.94 109.18 15111 156.17 148.36 170.61 15330 359.50 341.53 392.76 # 15111 126.93 120.58 138.67 # 15330 302.77 287.63 330.77 15115 963.35 915.18 1,052.46 15331 70.52 66.99 77.04 # 15115 853.42 810.75 932.36 # 15331 67.02 63.67 73.22 15116 200.96 190.91 219.55 15335 397.84 377.95 434.64 # 15116 174.06 165.36 190.16 # 15335 337.61 320.73 368.84 15120 1,051.72 999.13 1,149.00 15336 102.73 97.59 112.23 # 15120 879.21 835.25 960.54 # 15336 95.71 90.92 104.56 15121 379.87 360.88 415.01 15340 394.04 374.34 430.49 # 15121 224.32 213.10 245.07 # 15340 320.95 304.90 350.64 15130 883.46 839.29 965.18 15341 57.24 54.38 62.54 # 15130 677.04 643.19 739.67 # 15341 33.26 31.60 36.34 15131 128.01 121.61 139.85 15360 428.04 406.64 467.64 # 15131 102.86 97.72 112.38 # 15360 346.76 329.42 378.83 15135 1,031.06 979.51 1,126.44 15361 83.57 79.39 91.30 # 15135 928.72 882.28 1,014.62 # 15361 76.55 72.72 83.63 15136 117.23 111.37 128.08 15365 444.71 422.47 485.84 # 15136 104.37 99.15 114.02 # 15365 365.18 346.92 398.96 15150 855.41 812.64 934.54 15366 103.38 98.21 112.94 # 15150 737.29 700.43 805.49 # 15366 96.36 91.54 105.27 15151 163.85 155.66 179.01 15400 406.95 386.60 444.59 # 15151 136.96 130.11 149.63 15401 154.73 146.99 169.04 15152 200.29 190.28 218.82 # 15401 69.35 65.88 75.76 # 15152 171.05 162.50 186.88 15420 473.70 450.02 517.52 15155 845.90 803.61 924.15 # 15420 415.81 395.02 454.27 # 15155 795.61 755.83 869.20 15421 142.63 135.50 155.83 15156 210.58 200.05 230.06 # 15421 101.69 96.61 111.10 # 15156 191.86 182.27 209.61 15430 651.92 619.32 712.22 15157 234.22 222.51 255.89 # 15430 634.96 603.21 693.69 # 15157 209.08 198.63 228.42 15570 1,065.17 1,011.91 1,163.70 15170 438.97 417.02 479.57 # 15570 799.10 759.15 873.02 # 15170 353.01 335.36 385.66 15572 958.28 910.37 1,046.93 15171 106.72 101.38 116.59 # 15572 779.93 740.93 852.07 # 15171 103.21 98.05 112.76 15574 1,052.37 999.75 1,149.71 15175 619.54 588.56 676.84 # 15574 882.79 838.65 964.45 # 15175 535.92 509.12 585.49 15576 942.05 894.95 1,029.19 15176 170.48 161.96 186.25 # 15576 773.63 734.95 845.19 # 15176 163.47 155.30 178.60 15600 528.97 502.52 577.90 15200 897.78 852.89 980.82 # 15600 262.91 249.76 287.22 # 15200 710.07 674.57 775.76 15610 380.69 361.66 415.91 15201 208.00 197.60 227.24 # 15610 306.42 291.10 334.77 # 15201 93.97 89.27 102.66 15620 582.85 553.71 636.77 15220 875.03 831.28 955.97 # 15620 354.21 336.50 386.98 # 15220 728.26 691.85 795.63 15630 552.59 524.96 603.70 15221 188.00 178.60 205.39 # 15630 383.01 363.86 418.44 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 6 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 15650 588.13 558.72 642.53 # 15839 781.33 742.26 853.60 # 15650 416.21 395.40 454.71 15840 1,149.19 1,091.73 1,255.49 15732 1,822.38 1,731.26 1,990.95 15841 1,874.74 1,781.00 2,048.15 # 15732 1,480.88 1,406.84 1,617.87 15842 2,987.90 2,838.51 3,264.29 15734 1,839.76 1,747.77 2,009.94 15845 1,069.71 1,016.22 1,168.65 # 15734 1,503.52 1,428.34 1,642.59 15851 134.27 127.56 146.69 15736 1,782.17 1,693.06 1,947.02 # 15851 54.16 51.45 59.17 # 15736 1,371.08 1,302.53 1,497.91 15852 144.95 137.70 158.36 15738 1,837.78 1,745.89 2,007.77 # 15852 56.06 53.26 61.25 # 15738 1,471.14 1,397.58 1,607.22 15860 133.53 126.85 145.88 15740 1,020.61 969.58 1,115.02 # 15860 130.61 124.08 142.69 # 15740 910.68 865.15 994.92 15920 670.33 636.81 732.33 15750 1,022.96 971.81 1,117.58 15922 855.11 812.35 934.20 15756 2,732.73 2,596.09 2,985.50 15931 734.93 698.18 802.91 15757 2,775.20 2,636.44 3,031.91 15933 932.76 886.12 1,019.04 15758 2,777.20 2,638.34 3,034.09 15934 1,024.20 972.99 1,118.94 15760 959.35 911.38 1,048.09 15935 1,241.28 1,179.22 1,356.10 # 15760 797.37 757.50 871.13 15936 1,021.78 970.69 1,116.29 15770 719.38 683.41 785.92 15937 1,196.84 1,137.00 1,307.55 15775 419.44 398.47 458.24 15940 769.08 730.63 840.22 # 15775 247.52 235.14 270.41 15941 1,053.66 1,000.98 1,151.13 15776 553.93 526.23 605.16 15944 1,004.33 954.11 1,097.23 # 15776 404.23 384.02 441.62 15945 1,119.83 1,063.84 1,223.42 15780 984.37 935.15 1,075.42 15946 1,785.89 1,696.60 1,951.09 # 15780 792.57 752.94 865.88 15950 645.67 613.39 705.40 15781 608.06 577.66 664.31 15951 927.38 881.01 1,013.16 # 15781 517.42 491.55 565.28 15952 950.58 903.05 1,038.51 15782 759.27 721.31 829.51 15953 1,078.17 1,024.26 1,177.90 # 15782 565.71 537.42 618.03 15956 1,308.72 1,243.28 1,429.77 15783 581.74 552.65 635.55 15958 1,323.89 1,257.70 1,446.36 # 15783 423.86 402.67 463.07 16000 88.02 83.62 96.16 15786 280.74 266.70 306.71 # 16000 52.93 50.28 57.82 # 15786 161.45 153.38 176.39 16020 109.54 104.06 119.67 15787 77.98 74.08 85.19 # 16020 68.03 64.63 74.32 # 15787 23.60 22.42 25.78 16025 182.51 173.38 199.39 15788 480.21 456.20 524.63 # 16025 135.14 128.38 147.64 # 15788 267.36 253.99 292.09 16030 216.95 206.10 237.02 15789 676.41 642.59 738.98 # 16030 154.97 147.22 169.30 # 15789 483.44 459.27 528.16 16035 253.98 241.28 277.47 15792 493.69 469.01 539.36 16036 100.28 95.27 109.56 # 15792 338.73 321.79 370.06 17000 81.56 77.48 89.10 15793 522.92 496.77 571.29 # 17000 56.42 53.60 61.64 # 15793 411.24 390.68 449.28 17003 12.70 12.07 13.88 15819 821.36 780.29 897.33 # 17003 10.37 9.85 11.33 15820 625.10 593.85 682.93 17004 249.87 237.38 272.99 # 15820 542.64 515.51 592.84 # 17004 207.77 197.38 226.99 15821 671.45 637.88 733.56 17106 462.19 439.08 504.94 # 15821 575.55 546.77 628.79 # 17106 387.93 368.53 423.81 15822 529.57 503.09 578.55 17107 805.31 765.04 879.80 # 15822 450.63 428.10 492.32 # 17107 702.97 667.82 767.99 15823 755.35 717.58 825.22 17108 1,086.02 1,031.72 1,186.48 # 15823 672.31 638.69 734.49 # 17108 991.88 942.29 1,083.63 15831 1,018.83 967.89 1,113.07 17110 122.08 115.98 133.38 15832 994.59 944.86 1,086.59 # 17110 68.28 64.87 74.60 15833 944.64 897.41 1,032.02 17111 135.85 129.06 148.42 15834 925.63 879.35 1,011.25 # 17111 85.56 81.28 93.47 15835 949.55 902.07 1,037.38 17250 92.91 88.26 101.50 15836 805.49 765.22 880.00 # 17250 41.45 39.38 45.29 15837 868.49 825.07 948.83 17260 112.39 106.77 122.79 # 15837 799.49 759.52 873.45 # 17260 76.72 72.88 83.81 15838 655.86 623.07 716.53 17261 142.38 135.26 155.55 15839 924.02 877.82 1,009.49 # 17261 96.77 91.93 105.72 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 7 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 17262 175.47 166.70 191.71 19110 526.14 499.83 574.80 # 17262 124.60 118.37 136.13 # 19110 354.22 336.51 386.99 17263 194.09 184.39 212.05 19112 514.40 488.68 561.98 # 17263 137.37 130.50 150.08 # 19112 316.17 300.36 345.41 17264 210.31 199.79 229.76 19120 507.03 481.68 553.93 # 17264 145.40 138.13 158.85 # 19120 420.48 399.46 459.38 17266 243.00 230.85 265.48 19125 542.87 515.73 593.09 # 17266 167.56 159.18 183.06 # 19125 455.16 432.40 497.26 17270 153.67 145.99 167.89 19126 185.55 176.27 202.71 # 17270 105.13 99.87 114.85 19140 641.79 609.70 701.16 17271 165.42 157.15 180.72 # 19140 421.92 400.82 460.94 # 17271 118.64 112.71 129.62 19160 460.29 437.28 502.87 17272 189.78 180.29 207.33 19162 958.20 910.29 1,046.83 # 17272 137.74 130.85 150.48 19180 676.35 642.53 738.91 17273 213.56 202.88 233.31 19182 614.13 583.42 670.93 # 17273 155.08 147.33 169.43 19200 1,135.46 1,078.69 1,240.49 17274 256.79 243.95 280.54 19220 1,164.19 1,105.98 1,271.88 # 17274 190.72 181.18 208.36 19240 1,174.91 1,116.16 1,283.58 17276 305.00 289.75 333.21 19260 1,325.75 1,259.46 1,448.38 # 17276 230.74 219.20 252.08 19271 1,875.24 1,781.48 2,048.70 17280 142.38 135.26 155.55 19272 2,048.13 1,945.72 2,237.58 # 17280 95.60 90.82 104.44 19290 219.99 208.99 240.34 17281 182.51 173.38 199.39 # 19290 77.30 73.44 84.46 # 17281 134.56 127.83 147.00 19291 97.05 92.20 106.03 17282 210.23 199.72 229.68 # 19291 38.57 36.64 42.14 # 17282 156.43 148.61 170.90 19295 158.13 150.22 172.75 17283 257.88 244.99 281.74 19296 7,508.04 7,132.64 8,202.54 # 17283 195.90 186.11 214.03 # 19296 244.17 231.96 266.75 17284 303.49 288.32 331.57 19297 110.71 105.17 120.95 # 17284 235.07 223.32 256.82 19298 2,724.00 2,587.80 2,975.97 17286 398.82 378.88 435.71 # 19298 393.15 373.49 429.51 # 17286 326.90 310.56 357.14 19316 909.41 863.94 993.53 17304 795.31 755.54 868.87 19318 1,353.64 1,285.96 1,478.85 # 17304 521.06 495.01 569.26 19324 541.86 514.77 591.99 17305 345.26 328.00 377.20 19325 754.29 716.58 824.07 # 17305 195.56 185.78 213.65 19328 544.36 517.14 594.71 17306 346.43 329.11 378.48 19330 689.36 654.89 753.12 # 17306 196.14 186.33 214.28 19340 462.48 439.36 505.26 17307 325.96 309.66 356.11 19342 1,017.62 966.74 1,111.75 # 17307 196.73 186.89 214.92 19350 1,204.36 1,144.14 1,315.76 17310 133.63 126.95 145.99 # 19350 813.15 772.49 888.36 # 17310 65.80 62.51 71.89 19355 927.52 881.14 1,013.31 17340 53.40 50.73 58.34 # 19355 601.81 571.72 657.48 # 17340 52.82 50.18 57.71 19357 1,716.33 1,630.51 1,875.09 17360 143.13 135.97 156.37 19361 1,573.73 1,495.04 1,719.30 # 17360 109.80 104.31 119.96 19364 3,178.69 3,019.76 3,472.72 19000 152.08 144.48 166.15 19366 1,612.48 1,531.86 1,761.64 # 19000 53.85 51.16 58.83 19367 2,110.31 2,004.79 2,305.51 19001 32.48 30.86 35.49 19368 2,545.82 2,418.53 2,781.31 # 19001 26.05 24.75 28.46 19369 2,386.20 2,266.89 2,606.92 19020 525.43 499.16 574.03 19370 759.46 721.49 829.71 # 19020 310.83 295.29 339.58 19371 873.62 829.94 954.43 19030 231.51 219.93 252.92 19380 853.72 811.03 932.68 # 19030 92.92 88.27 101.51 19396 157.73 149.84 172.32 19100 177.18 168.32 193.57 # 19396 152.46 144.84 166.57 # 19100 79.52 75.54 86.87 20000 249.22 236.76 272.27 19101 401.09 381.04 438.20 # 20000 193.08 183.43 210.94 # 19101 249.64 237.16 272.73 20005 353.00 335.35 385.65 19102 308.34 292.92 336.86 # 20005 280.49 266.47 306.44 # 19102 122.39 116.27 133.71 20100 695.36 660.59 759.68 19103 829.28 787.82 905.99 20101 487.55 463.17 532.65 # 19103 227.56 216.18 248.61 # 20101 234.94 223.19 256.67 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 8 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 20102 607.36 576.99 663.54 20692 504.04 478.84 550.67 # 20102 281.65 267.57 307.71 20693 578.46 549.54 631.97 20103 733.90 697.21 801.79 20694 602.91 572.76 658.67 # 20103 429.83 408.34 469.59 # 20694 421.05 400.00 460.00 20150 1,011.48 960.91 1,105.05 20802 2,973.22 2,824.56 3,248.24 20200 242.09 229.99 264.49 20805 4,137.32 3,930.45 4,520.02 # 20200 108.18 102.77 118.19 20808 5,118.06 4,862.16 5,591.48 20205 330.60 314.07 361.18 20816 3,568.64 3,390.21 3,898.74 # 20205 172.13 163.52 188.05 20822 3,158.03 3,000.13 3,450.15 20206 422.76 401.62 461.86 20824 3,497.77 3,322.88 3,821.31 # 20206 78.34 74.42 85.58 20827 3,288.66 3,124.23 3,592.86 20220 320.23 304.22 349.85 20838 2,995.07 2,845.32 3,272.12 # 20220 99.19 94.23 108.36 20900 741.07 704.02 809.62 20225 1,514.38 1,438.66 1,654.46 # 20900 579.67 550.69 633.29 # 20225 146.63 139.30 160.20 20902 738.45 701.53 806.76 20240 290.31 275.79 317.16 20910 535.70 508.92 585.26 20245 729.81 693.32 797.32 20912 611.45 580.88 668.01 20250 432.08 410.48 472.05 20920 476.54 452.71 520.62 20251 495.17 470.41 540.97 20922 724.48 688.26 791.50 20500 185.11 175.85 202.23 # 20922 567.76 539.37 620.28 # 20500 141.84 134.75 154.96 20924 630.57 599.04 688.90 20501 202.27 192.16 220.98 20926 521.55 495.47 569.79 # 20501 46.14 43.83 50.40 20931 137.70 130.82 150.44 20520 250.25 237.74 273.40 20937 210.19 199.68 229.63 # 20520 183.00 173.85 199.93 20938 228.33 216.91 249.45 20525 689.00 654.55 752.73 20950 456.69 433.86 498.94 # 20525 306.57 291.24 334.93 # 20950 113.44 107.77 123.94 20526 97.69 92.81 106.73 20955 3,116.65 2,960.82 3,404.94 # 20526 71.38 67.81 77.98 20956 3,198.85 3,038.91 3,494.75 20550 73.87 70.18 80.71 20957 2,914.94 2,769.19 3,184.57 # 20550 45.80 43.51 50.04 20962 3,292.17 3,127.56 3,596.69 20551 71.87 68.28 78.52 20969 3,441.58 3,269.50 3,759.93 # 20551 51.40 48.83 56.15 20970 3,378.41 3,209.49 3,690.91 20552 69.85 66.36 76.31 20972 3,062.26 2,909.15 3,345.52 # 20552 39.44 37.47 43.09 20973 3,447.45 3,275.08 3,766.34 20553 79.07 75.12 86.39 20974 67.97 64.57 74.26 # 20553 43.98 41.78 48.05 # 20974 59.20 56.24 64.68 20600 66.50 63.18 72.66 20975 217.02 206.17 237.10 # 20600 48.95 46.50 53.48 20979 73.91 70.21 80.74 20605 73.73 70.04 80.55 # 20979 47.01 44.66 51.36 # 20605 50.34 47.82 54.99 20982 6,733.22 6,396.56 7,356.04 20610 90.00 85.50 98.33 # 20982 483.33 459.16 528.03 # 20610 59.01 56.06 64.47 21010 849.68 807.20 928.28 20612 72.10 68.50 78.78 21015 522.92 496.77 571.29 # 20612 51.64 49.06 56.42 21025 1,153.97 1,096.27 1,260.71 20615 302.36 287.24 330.33 # 21025 984.39 935.17 1,075.45 # 20615 204.71 194.47 223.64 21026 670.02 636.52 732.00 20650 235.82 224.03 257.63 # 21026 579.97 550.97 633.62 # 20650 187.87 178.48 205.25 21029 882.18 838.07 963.78 20660 294.32 279.60 321.54 # 21029 743.60 706.42 812.38 # 20660 209.53 199.05 228.91 21030 565.01 536.76 617.27 20661 511.86 486.27 559.21 # 21030 488.41 463.99 533.59 20662 581.21 552.15 634.97 21031 444.90 422.66 486.06 20663 523.94 497.74 572.40 # 21031 354.26 336.55 387.03 20664 779.15 740.19 851.22 21032 455.18 432.42 497.28 20665 183.62 174.44 200.61 # 21032 347.59 330.21 379.74 # 20665 136.25 129.44 148.86 21034 1,624.81 1,543.57 1,775.11 20670 753.37 715.70 823.06 # 21034 1,433.60 1,361.92 1,566.21 # 20670 200.19 190.18 218.71 21040 568.52 540.09 621.10 20680 663.16 630.00 724.50 # 21040 470.28 446.77 513.79 # 20680 366.10 347.80 399.97 21044 1,052.93 1,000.28 1,150.32 20690 302.92 287.77 330.94 21045 1,410.78 1,340.24 1,541.28 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 9 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21046 1,264.68 1,201.45 1,381.67 21175 2,492.85 2,368.21 2,723.44 21047 1,592.57 1,512.94 1,739.88 21179 1,790.29 1,700.78 1,955.90 21048 1,296.58 1,231.75 1,416.51 21180 1,997.86 1,897.97 2,182.67 21049 1,524.80 1,448.56 1,665.84 21181 867.26 823.90 947.49 21050 1,021.88 970.79 1,116.41 21182 2,481.17 2,357.11 2,710.68 21060 948.84 901.40 1,036.61 21183 2,748.28 2,610.87 3,002.50 21070 776.68 737.85 848.53 21184 2,960.84 2,812.80 3,234.72 21076 1,311.91 1,246.31 1,433.26 21188 2,049.10 1,946.65 2,238.65 # 21076 1,173.90 1,115.21 1,282.49 21193 1,484.81 1,410.57 1,622.16 21077 3,303.34 3,138.17 3,608.90 21194 1,652.01 1,569.41 1,804.82 # 21077 2,991.08 2,841.53 3,267.76 21195 1,600.76 1,520.72 1,748.83 21079 2,234.68 2,122.95 2,441.39 21196 1,729.91 1,643.41 1,889.92 # 21079 1,979.72 1,880.73 2,162.84 21198 1,348.53 1,281.10 1,473.27 21080 2,535.13 2,408.37 2,769.63 21199 1,210.70 1,150.17 1,322.70 # 21080 2,234.57 2,122.84 2,441.27 21206 1,339.31 1,272.34 1,463.19 21081 2,304.38 2,189.16 2,517.53 21208 1,746.32 1,659.00 1,907.85 # 21081 2,022.53 1,921.40 2,209.61 # 21208 998.99 949.04 1,091.40 21082 2,048.33 1,945.91 2,237.80 21209 925.05 878.80 1,010.62 # 21082 1,836.65 1,744.82 2,006.54 # 21209 764.82 726.58 835.57 21083 1,946.84 1,849.50 2,126.93 21210 1,900.61 1,805.58 2,076.42 # 21083 1,691.30 1,606.74 1,847.75 # 21210 990.73 941.19 1,082.37 21084 2,272.54 2,158.91 2,482.75 21215 2,925.57 2,779.29 3,196.18 # 21084 1,994.78 1,895.04 2,179.30 # 21215 1,018.68 967.75 1,112.91 21085 878.41 834.49 959.66 21230 934.98 888.23 1,021.46 # 21085 790.11 750.60 863.19 21235 861.76 818.67 941.47 21086 2,483.30 2,359.14 2,713.01 # 21235 660.60 627.57 721.71 # 21086 2,230.69 2,119.16 2,437.03 21240 1,325.26 1,259.00 1,447.85 21087 2,449.74 2,327.25 2,676.34 21242 1,238.14 1,176.23 1,352.66 # 21087 2,209.99 2,099.49 2,414.41 21243 1,936.30 1,839.49 2,115.41 21088 2,781.77 2,642.68 3,039.08 21244 1,215.78 1,154.99 1,328.24 21100 853.49 810.82 932.44 21245 1,349.38 1,281.91 1,474.20 # 21100 455.27 432.51 497.39 # 21245 1,082.73 1,028.59 1,182.88 21110 787.44 748.07 860.28 21246 1,063.82 1,010.63 1,162.22 # 21110 716.68 680.85 782.98 21247 1,995.17 1,895.41 2,179.72 21116 287.80 273.41 314.42 21248 1,210.26 1,149.75 1,322.21 # 21116 53.32 50.65 58.25 # 21248 1,050.03 997.53 1,147.16 21120 832.87 791.23 909.91 21249 1,744.42 1,657.20 1,905.78 # 21120 651.60 619.02 711.87 # 21249 1,508.18 1,432.77 1,647.69 21121 899.44 854.47 982.64 21255 1,675.32 1,591.55 1,830.28 # 21121 787.16 747.80 859.97 21256 1,379.52 1,310.54 1,507.12 21122 873.49 829.82 954.29 21260 1,435.25 1,363.49 1,568.01 21123 1,115.34 1,059.57 1,218.51 21261 2,768.33 2,629.91 3,024.40 21125 3,683.70 3,499.52 4,024.45 21263 2,323.34 2,207.17 2,538.25 # 21125 933.00 886.35 1,019.30 21267 1,959.55 1,861.57 2,140.81 21127 2,993.19 2,843.53 3,270.06 21268 2,257.14 2,144.28 2,465.92 # 21127 1,037.75 985.86 1,133.74 21270 1,110.91 1,055.36 1,213.66 21137 879.83 835.84 961.22 # 21270 853.03 810.38 931.94 21138 1,090.84 1,036.30 1,191.75 21275 960.88 912.84 1,049.77 21139 1,263.71 1,200.52 1,380.60 21280 599.54 569.56 654.99 21141 1,584.41 1,505.19 1,730.97 21282 408.77 388.33 446.58 21142 1,565.13 1,486.87 1,709.90 21295 213.94 203.24 233.73 21143 1,665.43 1,582.16 1,819.48 21296 466.42 443.10 509.57 21145 1,685.03 1,600.78 1,840.90 21300 170.72 162.18 186.51 21146 1,805.75 1,715.46 1,972.78 # 21300 47.33 44.96 51.70 21147 1,801.12 1,711.06 1,967.72 21310 158.44 150.52 173.10 21150 2,058.21 1,955.30 2,248.60 # 21310 33.30 31.64 36.39 21151 2,538.10 2,411.20 2,772.88 21315 312.05 296.45 340.92 21154 2,641.26 2,509.20 2,885.58 # 21315 174.63 165.90 190.79 21155 2,946.79 2,799.45 3,219.37 21320 307.98 292.58 336.47 21159 3,607.02 3,426.67 3,940.67 # 21320 173.49 164.82 189.54 21160 3,575.65 3,396.87 3,906.40 21325 663.92 630.72 725.33 21172 2,009.12 1,908.66 2,194.96 21330 798.51 758.58 872.37 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 10 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21335 928.02 881.62 1,013.86 # 21480 37.10 35.25 40.54 21336 806.65 766.32 881.27 21485 654.31 621.59 714.83 21337 474.41 450.69 518.29 # 21485 621.56 590.48 679.05 # 21337 324.71 308.47 354.74 21490 1,092.37 1,037.75 1,193.41 21338 1,101.51 1,046.43 1,203.39 21495 733.06 696.41 800.87 21339 1,163.42 1,105.25 1,271.04 21497 662.29 629.18 723.56 21340 952.58 904.95 1,040.69 # 21497 614.92 584.17 671.80 21343 1,462.64 1,389.51 1,597.94 21501 539.84 512.85 589.78 21344 1,818.70 1,727.77 1,986.94 # 21501 387.22 367.86 423.04 21345 927.25 880.89 1,013.02 21502 639.94 607.94 699.13 # 21345 770.54 732.01 841.81 21510 582.06 552.96 635.90 21346 1,171.01 1,112.46 1,279.33 21550 296.63 281.80 324.07 21347 1,494.89 1,420.15 1,633.17 # 21550 187.28 177.92 204.61 21348 1,381.86 1,312.77 1,509.69 21555 511.53 485.95 558.84 21355 524.91 498.66 573.46 # 21555 375.28 356.52 410.00 # 21355 363.51 345.33 397.13 21556 479.72 455.73 524.09 21356 595.18 565.42 650.23 21557 696.98 662.13 761.45 # 21356 444.31 422.09 485.40 21600 637.04 605.19 695.97 21360 625.29 594.03 683.13 21610 1,181.69 1,122.61 1,291.00 21365 1,276.50 1,212.68 1,394.58 21615 823.65 782.47 899.84 21366 1,438.36 1,366.44 1,571.41 21616 998.89 948.95 1,091.29 21385 876.85 833.01 957.96 21620 646.81 614.47 706.64 21386 806.09 765.79 880.66 21627 667.90 634.51 729.69 21387 941.02 893.97 1,028.07 21630 1,454.73 1,381.99 1,589.29 21390 885.62 841.34 967.54 21632 1,444.30 1,372.09 1,577.90 21395 1,073.30 1,019.64 1,172.59 21685 1,132.33 1,075.71 1,237.07 21400 213.15 202.49 232.86 21700 516.37 490.55 564.13 # 21400 169.88 161.39 185.60 21705 747.99 710.59 817.18 21401 608.73 578.29 665.03 21720 394.66 374.93 431.17 # 21401 345.00 327.75 376.91 21725 629.53 598.05 687.76 21406 655.91 623.11 716.58 21740 1,219.63 1,158.65 1,332.45 21407 770.98 732.43 842.29 21750 830.51 788.98 907.33 21408 1,053.06 1,000.41 1,150.47 21800 119.14 113.18 130.16 21421 771.42 732.85 842.78 21805 307.55 292.17 336.00 # 21421 711.19 675.63 776.97 21810 589.57 560.09 644.10 21422 831.90 790.31 908.86 21820 162.38 154.26 177.40 21423 995.06 945.31 1,087.11 # 21820 158.87 150.93 173.57 21431 858.52 815.59 937.93 21825 699.48 664.51 764.19 21432 837.94 796.04 915.45 21920 278.59 264.66 304.36 21433 2,047.25 1,944.89 2,236.62 # 21920 172.17 163.56 188.09 21435 1,485.58 1,411.30 1,623.00 21925 497.68 472.80 543.72 21436 2,269.39 2,155.92 2,479.31 # 21925 384.82 365.58 420.42 21440 534.19 507.48 583.60 21930 551.80 524.21 602.84 # 21440 479.22 455.26 523.55 # 21930 416.14 395.33 454.63 21445 806.86 766.52 881.50 21935 1,345.50 1,278.23 1,469.96 # 21445 725.58 689.30 792.70 22010 1,007.59 957.21 1,100.79 21450 560.17 532.16 611.98 22015 999.17 949.21 1,091.59 # 21450 530.35 503.83 579.40 22100 884.51 840.28 966.32 21451 759.28 721.32 829.52 22101 894.91 850.16 977.68 # 21451 703.14 667.98 768.18 22102 915.22 869.46 999.88 21452 849.90 807.41 928.52 22103 175.61 166.83 191.85 # 21452 356.36 338.54 389.32 22110 1,116.47 1,060.65 1,219.75 21453 870.19 826.68 950.68 22112 1,119.79 1,063.80 1,223.37 # 21453 869.60 826.12 950.04 22114 1,121.33 1,065.26 1,225.05 21454 646.56 614.23 706.36 22116 173.95 165.25 190.04 21461 1,783.17 1,694.01 1,948.11 22210 1,992.94 1,893.29 2,177.28 # 21461 1,091.41 1,036.84 1,192.37 22212 1,653.45 1,570.78 1,806.40 21462 2,043.40 1,941.23 2,232.41 22214 1,686.48 1,602.16 1,842.48 # 21462 1,169.78 1,111.29 1,277.98 22216 457.67 434.79 500.01 21465 1,090.05 1,035.55 1,190.88 22220 1,780.87 1,691.83 1,945.60 21470 1,368.41 1,299.99 1,494.99 22222 1,617.52 1,536.64 1,767.14 21480 130.07 123.57 142.11 22224 1,800.27 1,710.26 1,966.80 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 11 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 22226 455.33 432.56 497.44 # 23000 450.57 428.04 492.25 22305 227.64 216.26 248.70 23020 839.57 797.59 917.23 # 22305 204.83 194.59 223.78 23030 584.75 555.51 638.84 22310 281.50 267.43 307.54 # 23030 321.61 305.53 351.36 # 22310 255.19 242.43 278.79 23031 582.21 553.10 636.07 22315 968.16 919.75 1,057.71 # 23031 281.06 267.01 307.06 # 22315 830.15 788.64 906.94 23035 866.51 823.18 946.66 22318 1,777.49 1,688.62 1,941.91 23040 869.44 825.97 949.87 22319 1,973.79 1,875.10 2,156.37 23044 693.38 658.71 757.52 22325 1,537.55 1,460.67 1,679.77 23065 241.73 229.64 264.09 22326 1,639.78 1,557.79 1,791.46 # 23065 190.85 181.31 208.51 22327 1,593.38 1,513.71 1,740.77 23066 631.93 600.33 690.38 22328 340.72 323.68 372.23 # 23066 415.57 394.79 454.01 22505 138.97 132.02 151.82 23075 319.00 303.05 348.51 22520 4,015.86 3,815.07 4,387.33 # 23075 209.07 198.62 228.41 # 22520 698.52 663.59 763.13 23076 659.69 626.71 720.72 22521 3,656.35 3,473.53 3,994.56 23077 1,301.83 1,236.74 1,422.25 # 22521 664.14 630.93 725.57 23100 599.05 569.10 654.47 22522 291.21 276.65 318.15 23101 560.28 532.27 612.11 22523 740.59 703.56 809.09 23105 782.76 743.62 855.16 22524 710.51 674.98 776.23 23106 597.93 568.03 653.23 22525 330.65 314.12 361.24 23107 815.94 775.14 891.41 22532 1,938.53 1,841.60 2,117.84 23120 694.49 659.77 758.74 22533 1,802.30 1,712.19 1,969.02 23125 860.02 817.02 939.57 22534 449.23 426.77 490.79 23130 753.07 715.42 822.73 22548 2,100.37 1,995.35 2,294.65 23140 609.44 578.97 665.82 22554 1,580.50 1,501.48 1,726.70 23145 837.75 795.86 915.24 22556 1,911.57 1,815.99 2,088.39 23146 764.38 726.16 835.08 22558 1,751.01 1,663.46 1,912.98 23150 778.64 739.71 850.67 22585 416.32 395.50 454.83 23155 947.65 900.27 1,035.31 22590 1,721.88 1,635.79 1,881.16 23156 818.01 777.11 893.68 22595 1,638.86 1,556.92 1,790.46 23170 656.00 623.20 716.68 22600 1,395.44 1,325.67 1,524.52 23172 670.10 636.60 732.09 22610 1,398.55 1,328.62 1,527.91 23174 912.36 866.74 996.75 22612 1,785.12 1,695.86 1,950.24 23180 905.98 860.68 989.78 22614 488.83 464.39 534.05 23182 861.93 818.83 941.65 22630 1,750.02 1,662.52 1,911.90 23184 962.78 914.64 1,051.84 22632 394.44 374.72 430.93 23190 681.27 647.21 744.29 22800 1,573.51 1,494.83 1,719.05 23195 888.81 844.37 971.03 22802 2,539.26 2,412.30 2,774.15 23200 1,043.75 991.56 1,140.29 22804 2,958.12 2,810.21 3,231.74 23210 1,078.22 1,024.31 1,177.96 22808 2,131.16 2,024.60 2,328.29 23220 1,279.74 1,215.75 1,398.11 22810 2,417.08 2,296.23 2,640.66 23221 1,473.77 1,400.08 1,610.09 22812 2,618.39 2,487.47 2,860.59 23222 1,982.17 1,883.06 2,165.52 22818 2,542.14 2,415.03 2,777.28 23330 296.01 281.21 323.39 22819 2,826.52 2,685.19 3,087.97 # 23330 190.76 181.22 208.40 22830 958.19 910.28 1,046.82 23331 725.62 689.34 792.74 22840 952.21 904.60 1,040.29 23332 1,062.57 1,009.44 1,160.86 22842 953.41 905.74 1,041.60 23350 244.56 232.33 267.18 22843 997.33 947.46 1,089.58 # 23350 60.95 57.90 66.59 22844 1,251.49 1,188.92 1,367.26 23395 1,502.31 1,427.19 1,641.27 22845 906.08 860.78 989.90 23397 1,381.14 1,312.08 1,508.89 22846 942.23 895.12 1,029.39 23400 1,190.22 1,130.71 1,300.32 22847 1,039.00 987.05 1,135.11 23405 777.43 738.56 849.34 22848 455.54 432.76 497.67 23406 967.64 919.26 1,057.15 22849 1,526.01 1,449.71 1,667.17 23410 1,104.05 1,048.85 1,206.18 22850 842.27 800.16 920.18 23412 1,170.95 1,112.40 1,279.26 22851 502.97 477.82 549.49 23415 911.18 865.62 995.46 22852 806.39 766.07 880.98 23420 1,226.10 1,164.80 1,339.52 22855 1,260.22 1,197.21 1,376.79 23430 918.01 872.11 1,002.93 22900 440.22 418.21 480.94 23440 949.27 901.81 1,037.08 23000 691.49 656.92 755.46 23450 1,171.89 1,113.30 1,280.30 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 12 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 23455 1,250.13 1,187.62 1,365.76 23931 425.58 404.30 464.95 23460 1,348.88 1,281.44 1,473.66 # 23931 206.29 195.98 225.38 23462 1,308.09 1,242.69 1,429.09 23935 616.91 586.06 673.97 23465 1,359.52 1,291.54 1,485.27 24000 574.85 546.11 628.03 23466 1,297.75 1,232.86 1,417.79 24006 864.96 821.71 944.97 23470 1,479.92 1,405.92 1,616.81 24065 276.04 262.24 301.58 23472 1,781.68 1,692.60 1,946.49 # 24065 190.08 180.58 207.67 23480 1,010.76 960.22 1,104.25 24066 752.57 714.94 822.18 23485 1,176.26 1,117.45 1,285.07 # 24066 470.72 447.18 514.26 23490 1,021.80 970.71 1,116.32 24075 601.85 571.76 657.52 23491 1,258.75 1,195.81 1,375.18 # 24075 370.29 351.78 404.55 23500 259.37 246.40 283.36 24076 560.89 532.85 612.78 # 23500 238.90 226.96 261.00 24077 967.82 919.43 1,057.34 23505 421.34 400.27 460.31 24100 483.51 459.33 528.23 # 23505 388.01 368.61 423.90 24101 619.19 588.23 676.46 23515 713.03 677.38 778.99 24102 757.30 719.44 827.36 23520 262.40 249.28 286.67 24105 416.96 396.11 455.53 # 23520 255.97 243.17 279.65 24110 718.66 682.73 785.14 23525 421.63 400.55 460.63 24115 850.43 807.91 929.10 # 23525 386.54 367.21 422.29 24116 1,056.33 1,003.51 1,154.04 23530 670.79 637.25 732.84 24120 641.22 609.16 700.53 23532 764.16 725.95 834.84 24125 704.08 668.88 769.21 23540 264.56 251.33 289.03 24126 773.71 735.02 845.27 # 23540 235.32 223.55 257.08 24130 629.52 598.04 687.75 23545 384.79 365.55 420.38 24134 950.19 902.68 1,038.08 # 23545 336.26 319.45 367.37 24136 777.98 739.08 849.94 23550 694.94 660.19 759.22 24138 812.15 771.54 887.27 23552 804.28 764.07 878.68 24140 939.51 892.53 1,026.41 23570 275.06 261.31 300.51 24145 807.42 767.05 882.11 # 23570 268.04 254.64 292.84 24147 838.62 796.69 916.19 23575 463.20 440.04 506.05 24149 1,308.60 1,243.17 1,429.65 # 23575 429.87 408.38 469.64 24150 1,175.44 1,116.67 1,284.17 23585 845.45 803.18 923.66 24151 1,363.78 1,295.59 1,489.93 23600 396.19 376.38 432.84 24152 893.02 848.37 975.63 # 23600 337.72 320.83 368.95 24153 807.91 767.51 882.64 23605 576.75 547.91 630.10 24155 1,010.14 959.63 1,103.57 # 23605 515.35 489.58 563.02 24160 750.28 712.77 819.69 23615 933.26 886.60 1,019.59 24164 613.85 583.16 670.63 23616 1,773.46 1,684.79 1,937.51 24200 275.62 261.84 301.12 23620 317.96 302.06 347.37 # 24200 170.95 162.40 186.76 # 23620 281.12 267.06 307.12 24201 775.95 737.15 847.72 23625 463.46 440.29 506.33 # 24201 448.48 426.06 489.97 # 23625 424.86 403.62 464.16 24220 267.45 254.08 292.19 23630 715.05 679.30 781.20 # 24220 80.33 76.31 87.76 23650 364.22 346.01 397.91 24300 501.34 476.27 547.71 # 23650 305.16 289.90 333.39 24301 929.40 882.93 1,015.37 23655 444.63 422.40 485.76 24305 720.79 684.75 787.46 23660 706.55 671.22 771.90 24310 590.97 561.42 645.63 23665 509.53 484.05 556.66 24320 907.58 862.20 991.53 # 23665 473.27 449.61 517.05 24330 886.68 842.35 968.70 23670 751.06 713.51 820.54 24331 979.43 930.46 1,070.03 23675 668.11 634.70 729.91 24332 726.27 689.96 793.45 # 23675 609.64 579.16 666.03 24340 759.43 721.46 829.68 23680 921.90 875.81 1,007.18 24341 814.80 774.06 890.17 23700 239.56 227.58 261.72 24342 970.84 922.30 1,060.65 23800 1,236.49 1,174.67 1,350.87 24343 860.11 817.10 939.67 23802 1,329.11 1,262.65 1,452.05 24344 1,295.22 1,230.46 1,415.03 23900 1,555.93 1,478.13 1,699.85 24345 852.75 810.11 931.63 23920 1,228.63 1,167.20 1,342.28 24346 1,283.95 1,219.75 1,402.71 23921 537.02 510.17 586.70 24350 559.43 531.46 611.18 23930 499.45 474.48 545.65 24351 609.52 579.04 665.90 # 23930 264.38 251.16 288.83 24352 647.59 615.21 707.49 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 13 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 24354 647.10 614.75 706.96 24800 1,002.16 952.05 1,094.86 24356 665.48 632.21 727.04 24802 1,216.35 1,155.53 1,328.86 24360 1,101.01 1,045.96 1,202.85 24900 837.00 795.15 914.42 24361 1,239.02 1,177.07 1,353.63 24920 829.55 788.07 906.28 24362 1,254.36 1,191.64 1,370.39 24925 668.44 635.02 730.27 24363 1,619.87 1,538.88 1,769.71 24930 876.69 832.86 957.79 24365 793.62 753.94 867.03 24931 892.46 847.84 975.02 24366 845.94 803.64 924.19 24935 1,146.96 1,089.61 1,253.05 24400 1,010.13 959.62 1,103.56 25000 551.85 524.26 602.90 24410 1,262.58 1,199.45 1,379.37 25001 396.88 377.04 433.60 24420 1,210.73 1,150.19 1,322.72 25020 821.14 780.08 897.09 24430 1,139.62 1,082.64 1,245.04 25023 1,445.87 1,373.58 1,579.62 24435 1,222.23 1,161.12 1,335.29 25024 852.76 810.12 931.64 24470 839.81 797.82 917.49 25025 1,293.29 1,228.63 1,412.92 24495 867.73 824.34 947.99 25028 708.81 673.37 774.38 24498 1,072.10 1,018.50 1,171.28 25031 645.75 613.46 705.48 24500 425.48 404.21 464.84 25035 1,122.88 1,066.74 1,226.75 # 24500 357.06 339.21 390.09 25040 744.44 707.22 813.30 24505 616.35 585.53 673.36 25065 272.52 258.89 297.72 # 24505 545.60 518.32 596.07 # 25065 195.33 185.56 213.39 24515 1,067.29 1,013.93 1,166.02 25066 595.30 565.54 650.37 24516 1,051.50 998.93 1,148.77 25075 509.00 483.55 556.08 24530 459.50 436.53 502.01 25076 775.11 736.35 846.80 # 24530 391.09 371.54 427.27 25077 1,135.43 1,078.66 1,240.46 24535 764.31 726.09 835.00 25085 659.03 626.08 719.99 # 24535 692.97 658.32 757.07 25100 480.16 456.15 524.57 24538 929.37 882.90 1,015.34 25101 552.10 524.50 603.18 24545 959.58 911.60 1,048.34 25105 685.34 651.07 748.73 24546 1,360.54 1,292.51 1,486.39 25107 771.18 732.62 842.51 24560 385.89 366.60 421.59 25110 585.79 556.50 639.98 # 24560 310.46 294.94 339.18 25111 424.28 403.07 463.53 24565 633.59 601.91 692.20 25112 507.01 481.66 553.91 # 24565 569.85 541.36 622.56 25115 1,208.98 1,148.53 1,320.81 24566 822.94 781.79 899.06 25116 1,083.31 1,029.14 1,183.51 24575 965.68 917.40 1,055.01 25118 528.74 502.30 577.65 24576 405.17 384.91 442.65 25119 711.50 675.93 777.32 # 24576 343.77 326.58 375.57 25120 978.04 929.14 1,068.51 24577 662.04 628.94 723.28 25125 1,079.40 1,025.43 1,179.24 # 24577 598.30 568.39 653.65 25126 1,097.33 1,042.46 1,198.83 24579 1,033.12 981.46 1,128.68 25130 607.22 576.86 663.39 24582 914.05 868.35 998.60 25135 741.87 704.78 810.50 24586 1,333.77 1,267.08 1,457.14 25136 651.36 618.79 711.61 24587 1,316.52 1,250.69 1,438.29 25145 987.38 938.01 1,078.71 24600 466.64 443.31 509.81 25150 793.79 754.10 867.22 # 24600 387.11 367.75 422.91 25151 1,071.73 1,018.14 1,170.86 24605 553.88 526.19 605.12 25170 1,376.61 1,307.78 1,503.95 24615 875.94 832.14 956.96 25210 658.55 625.62 719.46 24620 673.04 639.39 735.30 25215 859.33 816.36 938.81 24635 1,409.23 1,338.77 1,539.59 25230 589.40 559.93 643.92 24640 159.35 151.38 174.09 25240 634.84 603.10 693.57 # 24640 97.95 93.05 107.01 25246 262.21 249.10 286.47 24650 317.03 301.18 346.36 # 25246 88.54 84.11 96.73 # 24650 256.80 243.96 280.55 25248 723.23 687.07 790.13 24655 542.72 515.58 592.92 25250 647.52 615.14 707.41 # 24655 474.31 450.59 518.18 25251 879.42 835.45 960.77 24665 801.70 761.62 875.86 25259 501.19 476.13 547.55 24666 893.86 849.17 976.55 25260 1,122.95 1,066.80 1,226.82 24670 353.07 335.42 385.73 25263 1,120.58 1,064.55 1,224.23 # 24670 292.26 277.65 319.30 25265 1,271.89 1,208.30 1,389.55 24675 561.22 533.16 613.13 25270 969.28 920.82 1,058.94 # 24675 500.40 475.38 546.69 25272 1,060.03 1,007.03 1,158.08 24685 831.51 789.93 908.42 25274 1,183.43 1,124.26 1,292.90 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 14 FSY06 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 25275 817.79 776.90 893.44 # 25560 259.27 246.31 283.26 25280 1,057.17 1,004.31 1,154.96 25565 641.66 609.58 701.02 25290 1,111.23 1,055.67 1,214.02 # 25565 566.82 538.48 619.25 25295 1,000.21 950.20 1,092.73 25574 733.25 696.59 801.08 25300 879.48 835.51 960.84 25575 1,021.50 970.43 1,115.99 25301 841.35 799.28 919.17 25600 355.76 337.97 388.67 25310 1,120.72 1,064.68 1,224.38 # 25600 290.27 275.76 317.12 25312 1,236.32 1,174.50 1,350.68 25605 681.61 647.53 744.66 25315 1,292.32 1,227.70 1,411.86 # 25605 622.55 591.42 680.13 25316 1,488.84 1,414.40 1,626.56 25611 870.49 826.97 951.02 25320 1,139.36 1,082.39 1,244.75 25620 803.80 763.61 878.15 25332 1,040.68 988.65 1,136.95 25622 365.24 346.98 399.03 25335 1,243.46 1,181.29 1,358.48 # 25622 296.82 281.98 324.28 25337 1,097.13 1,042.27 1,198.61 25624 569.89 541.40 622.61 25350 1,207.57 1,147.19 1,319.27 # 25624 497.38 472.51 543.39 25355 1,307.09 1,241.74 1,428.00 25628 830.49 788.97 907.32 25360 1,186.43 1,127.11 1,296.18 25630 371.81 353.22 406.20 25365 1,467.85 1,394.46 1,603.63 # 25630 299.30 284.34 326.99 25370 1,534.77 1,458.03 1,676.73 25635 542.72 515.58 592.92 25375 1,541.89 1,464.80 1,684.52 # 25635 422.85 401.71 461.97 25390 1,312.60 1,246.97 1,434.02 25645 709.31 673.84 774.92 25391 1,572.76 1,494.12 1,718.24 25650 386.24 366.93 421.97 25392 1,547.59 1,470.21 1,690.74 # 25650 319.58 303.60 349.14 25393 1,735.74 1,648.95 1,896.29 25651 557.75 529.86 609.34 25394 928.69 882.26 1,014.60 25652 745.25 707.99 814.19 25400 1,373.36 1,304.69 1,500.39 25660 481.13 457.07 525.63 25405 1,646.90 1,564.56 1,799.24 25670 759.25 721.29 829.48 25415 1,557.38 1,479.51 1,701.44 25671 626.09 594.79 684.01 25420 1,790.86 1,701.32 1,956.52 25675 534.05 507.35 583.45 25425 1,835.48 1,743.71 2,005.27 # 25675 474.99 451.24 518.93 25426 1,668.07 1,584.67 1,822.37 25676 783.68 744.50 856.18 25430 832.90 791.26 909.95 25680 537.23 510.37 586.93 25431 957.83 909.94 1,046.43 25685 889.23 844.77 971.49