1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 1 FSY06 LOCALITY FEE SCHEDULE FOR AREA 06 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 158.20 150.29 172.83 D0421 9.26 8.80 10.12 G0182 168.67 160.24 184.28 D0431 9.26 8.80 10.12 G0186 366.43 348.11 400.33 D0475 23.07 21.92 25.21 G0202 192.71 183.07 210.53 D0476 107.92 102.52 117.90 G0202 TC 150.13 142.62 164.01 D0477 80.43 76.41 87.87 G0202 26 42.58 40.45 46.52 D0478 134.92 128.17 147.40 G0204 200.45 190.43 218.99 D0479 169.25 160.79 184.91 G0204 TC 147.80 140.41 161.47 D0481 589.71 560.22 644.25 G0204 26 52.65 50.02 57.52 D0482 124.09 117.89 135.57 G0206 162.20 154.09 177.20 D0483 106.65 101.32 116.52 G0206 TC 119.62 113.64 130.69 D0484 97.91 93.01 106.96 G0206 26 42.58 40.45 46.52 # D0484 84.98 80.73 92.84 G0237 27.84 26.45 30.42 D0485 156.08 148.28 170.52 G0238 29.01 27.56 31.69 D7288 190.06 180.56 207.64 G0239 19.69 18.71 21.52 # D7288 124.06 117.86 135.54 G0245 82.74 78.60 90.39 D7321 407.10 386.75 444.76 # G0245 54.80 52.06 59.87 # D7321 313.18 297.52 342.15 G0246 50.22 47.71 54.87 D7511 335.32 318.55 366.33 # G0246 28.10 26.70 30.71 # D7511 263.33 250.16 287.68 G0247 51.09 48.54 55.82 D7521 195.61 185.83 213.70 # G0247 33.04 31.39 36.10 # D7521 121.94 115.84 133.22 G0248 386.18 366.87 421.90 G0101 49.05 46.60 53.59 G0249 231.34 219.77 252.74 # G0101 28.68 27.25 31.34 G0250 11.05 10.50 12.08 G0102 29.86 28.37 32.63 G0268 61.96 58.86 67.69 # G0102 10.65 10.12 11.64 # G0268 39.26 37.30 42.90 G0104 173.69 165.01 189.76 G0270 27.60 26.22 30.15 # G0104 70.08 66.58 76.57 G0271 10.72 10.18 11.71 G0105 515.89 490.10 563.62 G0275 16.23 15.42 17.73 # G0105 242.88 230.74 265.35 G0278 16.23 15.42 17.73 G0105 53 173.69 165.01 189.76 G0281 13.96 13.26 15.25 # G0105 53 70.08 66.58 76.57 G0283 13.96 13.26 15.25 G0106 193.39 183.72 211.28 G0288 623.72 592.53 681.41 G0106 TC 133.54 126.86 145.89 G0289 113.05 107.40 123.51 G0106 26 59.85 56.86 65.39 G0308 1,026.51 975.18 1,121.46 G0108 48.56 46.13 53.05 G0309 854.62 811.89 933.67 G0109 28.18 26.77 30.79 G0310 683.82 649.63 747.07 G0117 60.45 57.43 66.04 G0311 679.23 645.27 742.06 # G0117 29.60 28.12 32.34 G0312 565.58 537.30 617.90 G0118 38.01 36.11 41.53 G0313 452.60 429.97 494.47 # G0118 10.65 10.12 11.64 G0314 601.11 571.05 656.71 G0120 193.39 183.72 211.28 G0315 500.37 475.35 546.65 G0120 TC 133.54 126.86 145.89 G0316 400.30 380.29 437.33 G0120 26 59.85 56.86 65.39 G0317 378.16 359.25 413.14 G0121 515.89 490.10 563.62 G0318 314.93 299.18 344.06 # G0121 242.88 230.74 265.35 G0319 251.70 239.12 274.99 G0121 53 173.69 165.01 189.76 G0320 854.62 811.89 933.67 # G0121 53 70.08 66.58 76.57 G0321 565.58 537.30 617.90 G0124 26.29 24.98 28.73 G0322 500.37 475.35 546.65 G0127 21.71 20.62 23.71 G0323 314.93 299.18 344.06 # G0127 11.23 10.67 12.27 G0324 28.45 27.03 31.08 G0128 5.24 4.98 5.73 G0325 16.58 15.75 18.11 G0130 61.04 57.99 66.69 G0326 18.79 17.85 20.53 G0130 TC 47.78 45.39 52.20 G0327 10.59 10.06 11.57 G0130 26 13.26 12.60 14.49 G0329 10.83 10.29 11.83 G0141 26.29 24.98 28.73 # G0329 3.85 3.66 4.21 G0166 211.48 200.91 231.05 G0332 111.18 105.62 121.46 # G0166 4.83 4.59 5.28 G0341 630.17 598.66 688.46 G0168 131.95 125.35 144.15 # G0341 446.81 424.47 488.14 # G0168 31.83 30.24 34.78 G0342 829.17 787.71 905.87 G0179 78.74 74.80 86.02 G0343 1,368.16 1,299.75 1,494.71 G0180 101.32 96.25 110.69 G0344 122.69 116.56 134.04 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 06 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 84.85 80.61 92.70 11006 826.67 785.34 903.14 G0364 15.62 14.84 17.07 11008 336.26 319.45 367.37 # G0364 10.97 10.42 11.98 11010 587.44 558.07 641.78 G0365 249.06 236.61 272.10 # 11010 339.46 322.49 370.86 G0365 TC 233.17 221.51 254.74 11011 694.96 660.21 759.24 G0365 26 15.89 15.10 17.37 # 11011 355.60 337.82 388.49 G0366 37.33 35.46 40.78 11012 1,014.13 963.42 1,107.93 G0367 26.68 25.35 29.15 # 11012 531.56 504.98 580.73 G0368 10.65 10.12 11.64 11040 52.05 49.45 56.87 G0372 29.86 28.37 32.63 # 11040 34.01 32.31 37.16 # G0372 10.65 10.12 11.64 11041 74.19 70.48 81.05 G0375 15.24 14.48 16.65 # 11041 54.98 52.23 60.06 G0376 30.24 28.73 33.04 11042 105.16 99.90 114.89 # G0376 29.66 28.18 32.41 # 11042 74.30 70.59 81.18 M0064 35.08 33.33 38.33 11043 301.86 286.77 329.79 # M0064 22.27 21.16 24.33 # 11043 255.88 243.09 279.55 P3001 26.29 24.98 28.73 11044 394.46 374.74 430.95 Q0035 33.83 32.14 36.96 # 11044 353.72 336.03 386.43 Q0035 TC 23.19 22.03 25.33 11055 51.29 48.73 56.04 Q0035 26 10.65 10.12 11.64 # 11055 28.59 27.16 31.23 Q0091 54.53 51.80 59.57 11056 63.75 60.56 69.64 # Q0091 23.68 22.50 25.88 # 11056 39.89 37.90 43.59 Q0092 18.87 17.93 20.62 11057 77.62 73.74 84.80 R0070 174.06 165.36 190.16 # 11057 52.01 49.41 56.82 R0075 174.06 165.36 190.16 11100 106.43 101.11 116.28 0016T 366.43 348.11 400.33 # 11100 55.20 52.44 60.31 0024T 703.94 668.74 769.05 11101 36.37 34.55 39.73 0030T 26.18 24.87 28.60 # 11101 28.22 26.81 30.83 0067T 601.08 571.03 656.68 11200 92.82 88.18 101.41 0067T TC 529.03 502.58 577.97 # 11200 76.52 72.69 83.59 0067T 26 72.05 68.45 78.72 11201 21.59 20.51 23.59 0073T 1,055.01 1,002.26 1,152.60 # 11201 19.26 18.30 21.05 10021 179.80 170.81 196.43 11300 79.09 75.14 86.41 # 10021 85.50 81.23 93.41 # 11300 33.69 32.01 36.81 10022 202.02 191.92 220.71 11301 100.15 95.14 109.41 # 10022 78.03 74.13 85.25 # 11301 57.65 54.77 62.99 10040 107.99 102.59 117.98 11302 119.58 113.60 130.64 # 10040 95.18 90.42 103.98 # 11302 70.68 67.15 77.22 10060 120.92 114.87 132.10 11303 144.09 136.89 157.42 # 10060 104.62 99.39 114.30 # 11303 82.39 78.27 90.01 10061 210.42 199.90 229.89 11305 78.42 74.50 85.68 # 10061 191.21 181.65 208.90 # 11305 44.66 42.43 48.79 10080 231.28 219.72 252.68 11306 105.98 100.68 115.78 # 10080 114.85 109.11 125.48 # 11306 66.40 63.08 72.54 10081 342.94 325.79 374.66 11307 123.14 116.98 134.53 # 10081 192.75 183.11 210.58 # 11307 76.58 72.75 83.66 10120 179.42 170.45 196.02 11308 144.89 137.65 158.30 # 10120 108.98 103.53 119.06 # 11308 94.83 90.09 103.60 10121 322.28 306.17 352.10 11310 95.27 90.51 104.09 # 10121 221.57 210.49 242.06 # 11310 49.28 46.82 53.84 10140 170.43 161.91 186.20 11311 115.51 109.73 126.19 # 10140 141.91 134.81 155.03 # 11311 72.43 68.81 79.13 10160 145.32 138.05 158.76 11312 132.91 126.26 145.20 # 10160 115.05 109.30 125.70 # 11312 82.27 78.16 89.88 10180 274.02 260.32 299.37 11313 173.66 164.98 189.73 # 10180 215.81 205.02 235.77 # 11313 110.21 104.70 120.41 11000 59.86 56.87 65.40 11400 152.44 144.82 166.54 # 11000 38.90 36.96 42.50 # 11400 87.24 82.88 95.31 11001 26.56 25.23 29.01 11401 172.35 163.73 188.29 # 11001 19.57 18.59 21.38 # 11401 111.81 106.22 122.15 11004 663.07 629.92 724.41 11402 194.36 184.64 212.34 11005 907.19 861.83 991.10 # 11402 127.42 121.05 139.21 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 06 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 216.61 205.78 236.65 11624 349.26 331.80 381.57 # 11403 153.74 146.05 167.96 # 11624 234.59 222.86 256.29 11404 246.60 234.27 269.41 11626 455.44 432.67 497.57 # 11404 170.35 161.83 186.10 # 11626 325.05 308.80 355.12 11406 298.69 283.76 326.32 11640 212.40 201.78 232.05 # 11406 216.03 205.23 236.01 # 11640 122.17 116.06 133.47 11420 145.06 137.81 158.48 11641 268.09 254.69 292.89 # 11420 96.17 91.36 105.06 # 11641 180.77 171.73 197.49 11421 181.39 172.32 198.17 11642 308.42 293.00 336.95 # 11421 125.50 119.23 137.11 # 11642 209.46 198.99 228.84 11422 201.71 191.62 220.36 11643 354.14 336.43 386.89 # 11422 147.58 140.20 161.23 # 11643 247.03 234.68 269.88 11423 237.34 225.47 259.29 11644 445.44 423.17 486.65 # 11423 170.98 162.43 186.79 # 11644 315.63 299.85 344.83 11424 268.44 255.02 293.27 11646 592.19 562.58 646.97 # 11424 198.00 188.10 216.32 # 11646 458.89 435.95 501.34 11426 367.11 348.75 401.06 11719 21.95 20.85 23.98 # 11426 286.78 272.44 313.31 # 11719 11.47 10.90 12.54 11440 173.69 165.01 189.76 11720 33.77 32.08 36.89 # 11440 121.30 115.24 132.53 # 11720 20.97 19.92 22.91 11441 199.54 189.56 217.99 11721 49.27 46.81 53.83 # 11441 150.06 142.56 163.94 # 11721 35.88 34.09 39.20 11442 222.25 211.14 242.81 11730 109.30 103.84 119.42 # 11442 165.21 156.95 180.49 # 11730 74.37 70.65 81.25 11443 268.42 255.00 293.25 11732 50.49 47.97 55.17 # 11443 204.39 194.17 223.30 # 11732 37.68 35.80 41.17 11444 337.52 320.64 368.74 11740 48.03 45.63 52.47 # 11444 262.43 249.31 286.71 # 11740 36.39 34.57 39.76 11446 428.34 406.92 467.96 11750 207.28 196.92 226.46 # 11446 354.41 336.69 387.19 # 11750 183.41 174.24 200.38 11450 412.63 392.00 450.80 11752 291.68 277.10 318.67 # 11450 237.41 225.54 259.37 11755 148.05 140.65 161.75 11451 558.40 530.48 610.05 # 11755 101.48 96.41 110.87 # 11451 321.49 305.42 351.23 11760 222.43 211.31 243.01 11462 407.85 387.46 445.58 # 11760 173.53 164.85 189.58 # 11462 227.40 216.03 248.43 11762 294.47 279.75 321.71 11463 571.45 542.88 624.31 # 11762 263.03 249.88 287.36 # 11463 329.88 313.39 360.40 11765 134.19 127.48 146.60 11470 436.97 415.12 477.39 # 11765 74.24 70.53 81.11 # 11470 273.98 260.28 299.32 11770 317.28 301.42 346.63 11471 584.14 554.93 638.17 # 11770 201.44 191.37 220.08 # 11471 354.21 336.50 386.98 11771 580.40 551.38 634.09 11600 209.37 198.90 228.74 # 11771 444.18 421.97 485.27 # 11600 112.16 106.55 122.53 11772 742.72 705.58 811.42 11601 233.85 222.16 255.48 # 11772 600.69 570.66 656.26 # 11601 147.12 139.76 160.72 11900 59.47 56.50 64.98 11602 246.94 234.59 269.78 # 11900 33.85 32.16 36.98 # 11602 155.55 147.77 169.94 11901 71.68 68.10 78.32 11603 272.22 258.61 297.40 # 11901 53.63 50.95 58.59 # 11603 170.35 161.83 186.10 11920 287.24 272.88 313.81 11604 299.19 284.23 326.86 # 11920 134.73 127.99 147.19 # 11604 183.35 174.18 200.31 11921 316.60 300.77 345.89 11606 384.71 365.47 420.29 # 11921 159.43 151.46 174.18 # 11606 249.08 236.63 272.12 11922 87.98 83.58 96.12 11620 201.92 191.82 220.59 # 11922 36.17 34.36 39.51 # 11620 105.87 100.58 115.67 11950 101.97 96.87 111.40 11621 232.23 220.62 253.71 # 11950 58.31 55.39 63.70 # 11621 146.66 139.33 160.23 11951 137.79 130.90 150.54 11622 261.26 248.20 285.43 # 11951 80.74 76.70 88.21 # 11622 169.29 160.83 184.95 11952 180.87 171.83 197.60 11623 305.40 290.13 333.65 # 11952 112.18 106.57 122.56 # 11623 202.95 192.80 221.72 11954 223.90 212.71 244.62 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 06 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 133.67 126.99 146.04 # 12045 290.84 276.30 317.75 11960 1,007.10 956.75 1,100.26 12046 565.03 536.78 617.30 11970 670.10 636.60 732.09 # 12046 346.15 328.84 378.17 11971 626.41 595.09 684.35 12047 572.95 544.30 625.95 # 11971 315.56 299.78 344.75 # 12047 382.60 363.47 417.99 11976 177.59 168.71 194.02 12051 296.21 281.40 323.61 # 11976 117.05 111.20 127.88 # 12051 189.69 180.21 207.24 11980 126.20 119.89 137.87 12052 304.78 289.54 332.97 # 11980 94.76 90.02 103.52 # 12052 200.00 190.00 218.50 11981 162.05 153.95 177.04 12053 321.63 305.55 351.38 # 11981 102.67 97.54 112.17 # 12053 221.50 210.43 241.99 11982 190.01 180.51 207.59 12054 355.37 337.60 388.24 # 11982 124.81 118.57 136.36 # 12054 242.44 230.32 264.87 11983 273.06 259.41 298.32 12055 452.00 429.40 493.81 # 11983 225.33 214.06 246.17 # 12055 314.62 298.89 343.72 12001 188.60 179.17 206.05 12056 621.05 590.00 678.50 # 12001 117.58 111.70 128.46 # 12056 405.08 384.83 442.55 12002 199.08 189.13 217.50 12057 613.51 582.83 670.25 # 12002 132.14 125.53 144.36 # 12057 474.38 450.66 518.26 12004 231.80 220.21 253.24 13100 369.50 351.03 403.68 # 12004 154.97 147.22 169.30 # 13100 267.63 254.25 292.39 12005 287.57 273.19 314.17 13101 437.14 415.28 477.57 # 12005 192.69 183.06 210.52 # 13101 321.88 305.79 351.66 12006 355.22 337.46 388.08 13102 121.68 115.60 132.94 # 12006 245.20 232.94 267.88 # 13102 86.75 82.41 94.77 12007 400.97 380.92 438.06 13120 382.06 362.96 417.40 # 12007 283.97 269.77 310.24 # 13120 277.28 263.42 302.93 12011 200.01 190.01 218.51 13121 464.63 441.40 507.61 # 12011 120.85 114.81 132.03 # 13121 344.71 327.47 376.59 12013 218.00 207.10 238.17 13122 150.09 142.59 163.98 # 12013 139.42 132.45 152.32 # 13122 98.86 93.92 108.01 12014 255.79 243.00 279.45 13131 414.39 393.67 452.72 # 12014 167.31 158.94 182.78 # 13131 316.59 300.76 345.87 12015 319.52 303.54 349.07 13132 593.90 564.21 648.84 # 12015 209.50 199.03 228.88 # 13132 492.03 467.43 537.54 12016 375.59 356.81 410.33 13133 190.04 180.54 207.62 # 12016 256.84 244.00 280.60 # 13133 153.37 145.70 167.56 12017 313.10 297.45 342.07 13150 446.82 424.48 488.15 12018 371.52 352.94 405.88 # 13150 324.00 307.80 353.97 12020 336.75 319.91 367.90 13151 468.05 444.65 511.35 # 12020 226.15 214.84 247.07 # 13151 371.42 352.85 405.78 12021 187.16 177.80 204.47 13152 618.86 587.92 676.11 # 12021 162.71 154.57 177.76 # 13152 502.44 477.32 548.92 12031 224.85 213.61 245.65 13153 215.52 204.74 235.45 # 12031 147.43 140.06 161.07 # 13153 168.95 160.50 184.58 12032 328.43 312.01 358.81 13160 880.59 836.56 962.04 # 12032 209.09 198.64 228.44 14000 711.51 675.93 777.32 12034 311.07 295.52 339.85 # 14000 572.39 543.77 625.34 # 12034 209.20 198.74 228.55 14001 913.38 867.71 997.87 12035 451.79 429.20 493.58 # 14001 776.59 737.76 848.42 # 12035 274.25 260.54 299.62 14020 785.42 746.15 858.07 12036 501.83 476.74 548.25 # 14020 664.35 631.13 725.80 # 12036 326.04 309.74 356.20 14021 1,010.57 960.04 1,104.05 12037 561.14 533.08 613.04 # 14021 911.03 865.48 995.30 # 12037 378.36 359.44 413.36 14040 848.63 806.20 927.13 12041 249.41 236.94 272.48 # 14040 754.91 717.16 824.73 # 12041 166.75 158.41 182.17 14041 1,102.29 1,047.18 1,204.26 12042 305.88 290.59 334.18 # 14041 990.53 941.00 1,082.15 # 12042 200.52 190.49 219.06 14060 874.54 830.81 955.43 12044 321.66 305.58 351.42 # 14060 795.37 755.60 868.94 # 12044 227.36 215.99 248.39 14061 1,194.34 1,134.62 1,304.81 12045 464.89 441.65 507.90 # 14061 1,072.10 1,018.50 1,171.28 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 5 FSY06 LOCALITY FEE SCHEDULE FOR AREA 06 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 1,155.12 1,097.36 1,261.96 # 15221 84.86 80.62 92.71 # 14300 1,041.02 988.97 1,137.32 15240 984.97 935.72 1,076.08 14350 839.61 797.63 917.27 # 15240 853.41 810.74 932.35 15000 396.53 376.70 433.21 15241 223.82 212.63 244.52 # 15000 302.81 287.67 330.82 # 15241 134.18 127.47 146.59 15001 122.64 116.51 133.99 15260 1,021.05 970.00 1,115.50 # 15001 67.92 64.52 74.20 # 15260 925.59 879.31 1,011.21 15040 353.16 335.50 385.83 15261 252.93 240.28 276.32 # 15040 152.92 145.27 167.06 # 15261 177.26 168.40 193.66 15050 591.65 562.07 646.38 15300 360.97 342.92 394.36 # 15050 486.29 461.98 531.28 # 15300 304.51 289.28 332.67 15100 1,133.22 1,076.56 1,238.04 15301 71.41 67.84 78.02 # 15100 854.97 812.22 934.05 # 15301 67.34 63.97 73.57 15101 293.46 278.79 320.61 15320 416.47 395.65 455.00 # 15101 143.86 136.67 157.17 # 15320 353.02 335.37 385.68 15110 1,040.88 988.84 1,137.17 15321 106.25 100.94 116.08 # 15110 826.67 785.34 903.14 # 15321 100.43 95.41 109.72 15111 156.62 148.79 171.11 15330 360.39 342.37 393.73 # 15111 127.51 121.13 139.30 # 15330 303.93 288.73 332.04 15115 965.21 916.95 1,054.49 15331 70.83 67.29 77.38 # 15115 855.77 812.98 934.93 # 15331 67.34 63.97 73.57 15116 201.62 191.54 220.27 15335 398.88 378.94 435.78 # 15116 174.85 166.11 191.03 # 15335 338.92 321.97 370.27 15120 1,053.18 1,000.52 1,150.60 15336 103.16 98.00 112.70 # 15120 881.45 837.38 962.99 # 15336 96.17 91.36 105.06 15121 379.82 360.83 414.95 15340 394.62 374.89 431.12 # 15121 224.98 213.73 245.79 # 15340 321.86 305.77 351.64 15130 883.84 839.65 965.60 15341 57.29 54.43 62.59 # 15130 678.36 644.44 741.11 # 15341 33.43 31.76 36.52 15131 128.37 121.95 140.24 15360 428.57 407.14 468.21 # 15131 103.34 98.17 112.90 # 15360 347.65 330.27 379.81 15135 1,033.04 981.39 1,128.60 15361 83.92 79.72 91.68 # 15135 931.17 884.61 1,017.30 # 15361 76.93 73.08 84.04 15136 117.65 111.77 128.54 15365 445.34 423.07 486.53 # 15136 104.84 99.60 114.54 # 15365 366.17 347.86 400.04 15150 856.71 813.87 935.95 15366 103.83 98.64 113.44 # 15150 739.13 702.17 807.50 # 15366 96.84 92.00 105.80 15151 164.36 156.14 179.56 15400 407.64 387.26 445.35 # 15151 137.59 130.71 150.32 15401 154.65 146.92 168.96 15152 200.94 190.89 219.52 # 15401 69.67 66.19 76.12 # 15152 171.84 163.25 187.74 15420 474.41 450.69 518.29 15155 847.77 805.38 926.19 # 15420 416.78 395.94 455.33 # 15155 797.71 757.82 871.49 15421 142.92 135.77 156.14 15156 211.35 200.78 230.90 # 15421 102.17 97.06 111.62 # 15156 192.73 183.09 210.55 15430 652.62 619.99 712.99 15157 235.05 223.30 256.80 # 15430 635.74 603.95 694.54 # 15157 210.02 199.52 229.45 15570 1,066.08 1,012.78 1,164.70 15170 440.17 418.16 480.88 # 15570 801.23 761.17 875.35 # 15170 354.60 336.87 387.40 15572 959.77 911.78 1,048.55 15171 107.21 101.85 117.13 # 15572 782.23 743.12 854.59 # 15171 103.72 98.53 113.31 15574 1,053.85 1,001.16 1,151.33 15175 621.17 590.11 678.63 # 15574 885.04 840.79 966.91 # 15175 537.93 511.03 587.68 15576 943.33 896.16 1,030.58 15176 171.26 162.70 187.11 # 15576 775.68 736.90 847.44 # 15176 164.28 156.07 179.48 15600 527.77 501.38 576.59 15200 898.78 853.84 981.92 # 15600 262.91 249.76 287.22 # 15200 711.93 676.33 777.78 15610 380.47 361.45 415.67 15201 207.88 197.49 227.11 # 15610 306.54 291.21 334.89 # 15201 94.37 89.65 103.10 15620 582.07 552.97 635.92 15220 876.08 832.28 957.12 # 15620 354.47 336.75 387.26 # 15220 729.97 693.47 797.49 15630 552.17 524.56 603.24 15221 187.90 178.51 205.29 # 15630 383.36 364.19 418.82 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 06 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 587.99 558.59 642.38 # 15839 783.70 744.52 856.20 # 15650 416.85 396.01 455.41 15840 1,152.46 1,094.84 1,259.07 15732 1,825.45 1,734.18 1,994.31 15841 1,881.04 1,786.99 2,055.04 # 15732 1,485.50 1,411.23 1,622.91 15842 2,998.23 2,848.32 3,275.57 15734 1,842.50 1,750.38 2,012.94 15845 1,073.05 1,019.40 1,172.31 # 15734 1,507.79 1,432.40 1,647.26 15851 134.22 127.51 146.64 15736 1,784.21 1,695.00 1,949.25 # 15851 54.47 51.75 59.51 # 15736 1,374.99 1,306.24 1,502.18 15852 144.84 137.60 158.24 15738 1,840.61 1,748.58 2,010.87 # 15852 56.36 53.54 61.57 # 15738 1,475.63 1,401.85 1,612.13 15860 134.15 127.44 146.56 15740 1,022.67 971.54 1,117.27 # 15860 131.24 124.68 143.38 # 15740 913.23 867.57 997.71 15920 672.29 638.68 734.48 15750 1,025.52 974.24 1,120.38 15922 857.42 814.55 936.73 15756 2,742.50 2,605.38 2,996.19 15931 737.40 700.53 805.61 15757 2,785.02 2,645.77 3,042.64 15933 935.32 888.55 1,021.83 15758 2,786.80 2,647.46 3,044.58 15934 1,027.50 976.13 1,122.55 15760 960.60 912.57 1,049.46 15935 1,244.75 1,182.51 1,359.89 # 15760 799.35 759.38 873.29 15936 1,024.88 973.64 1,119.69 15770 720.82 684.78 787.50 15937 1,200.28 1,140.27 1,311.31 15775 420.03 399.03 458.88 15940 771.44 732.87 842.80 # 15775 248.89 236.45 271.92 15941 1,056.01 1,003.21 1,153.69 15776 554.90 527.16 606.23 15944 1,006.93 956.58 1,100.07 # 15776 405.88 385.59 443.43 15945 1,122.67 1,066.54 1,226.52 15780 984.59 935.36 1,075.66 15946 1,791.24 1,701.68 1,956.93 # 15780 793.66 753.98 867.08 15950 647.47 615.10 707.37 15781 608.45 578.03 664.73 15951 929.89 883.40 1,015.91 # 15781 518.22 492.31 566.16 15952 953.39 905.72 1,041.58 15782 758.62 720.69 828.79 15953 1,081.18 1,027.12 1,181.19 # 15782 565.94 537.64 618.29 15956 1,312.48 1,246.86 1,433.89 15783 581.89 552.80 635.72 15958 1,327.54 1,261.16 1,450.33 # 15783 424.72 403.48 464.00 16000 88.19 83.78 96.35 15786 280.80 266.76 306.77 # 16000 53.26 50.60 58.19 # 15786 162.05 153.95 177.04 16020 109.56 104.08 119.69 15787 77.84 73.95 85.04 # 16020 68.23 64.82 74.54 # 15787 23.70 22.52 25.90 16025 182.86 173.72 199.78 15788 479.41 455.44 523.76 # 16025 135.71 128.92 148.26 # 15788 267.52 254.14 292.26 16030 217.29 206.43 237.39 15789 676.59 642.76 739.17 # 16030 155.59 147.81 169.98 # 15789 484.50 460.28 529.32 16035 255.20 242.44 278.81 15792 492.66 468.03 538.23 16036 100.77 95.73 110.09 # 15792 338.40 321.48 369.70 17000 81.59 77.51 89.14 15793 523.00 496.85 571.38 # 17000 56.56 53.73 61.79 # 15793 411.82 391.23 449.91 17003 12.74 12.10 13.92 15819 823.63 782.45 899.82 # 17003 10.42 9.90 11.39 15820 625.59 594.31 683.46 17004 250.58 238.05 273.76 # 15820 543.51 516.33 593.78 # 17004 208.67 198.24 227.98 15821 672.10 638.50 734.28 17106 463.07 439.92 505.91 # 15821 576.64 547.81 629.98 # 17106 389.14 369.68 425.13 15822 530.04 503.54 579.07 17107 807.61 767.23 882.31 # 15822 451.46 428.89 493.22 # 17107 705.74 670.45 771.02 15823 756.50 718.68 826.48 17108 1,089.80 1,035.31 1,190.61 # 15823 673.84 640.15 736.17 # 17108 996.09 946.29 1,088.23 15831 1,021.96 970.86 1,116.49 17110 121.94 115.84 133.22 15832 997.32 947.45 1,089.57 # 17110 68.39 64.97 74.72 15833 947.01 899.66 1,034.61 17111 135.83 129.04 148.40 15834 928.18 881.77 1,014.04 # 17111 85.77 81.48 93.70 15835 952.55 904.92 1,040.66 17250 92.80 88.16 101.38 15836 807.68 767.30 882.40 # 17250 41.58 39.50 45.43 15837 869.83 826.34 950.29 17260 112.48 106.86 122.89 # 15837 801.14 761.08 875.24 # 17260 76.97 73.12 84.09 15838 657.49 624.62 718.31 17261 142.51 135.38 155.69 15839 925.73 879.44 1,011.36 # 17261 97.10 92.25 106.09 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 06 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 175.72 166.93 191.97 19110 526.46 500.14 575.16 # 17262 125.08 118.83 136.65 # 19110 355.32 337.55 388.18 17263 194.40 184.68 212.38 19112 514.37 488.65 561.95 # 17263 137.93 131.03 150.68 # 19112 317.04 301.19 346.37 17264 210.64 200.11 230.13 19120 508.22 482.81 555.23 # 17264 146.02 138.72 159.53 # 19120 422.07 400.97 461.12 17266 243.44 231.27 265.96 19125 544.22 517.01 594.56 # 17266 168.35 159.93 183.92 # 19125 456.90 434.06 499.17 17270 153.85 146.16 168.08 19126 186.56 177.23 203.81 # 17270 105.53 100.25 115.29 19140 642.10 610.00 701.50 17271 165.66 157.38 180.99 # 19140 423.23 402.07 462.38 # 17271 119.09 113.14 130.11 19160 461.96 438.86 504.69 17272 190.09 180.59 207.68 19162 962.36 914.24 1,051.38 # 17272 138.28 131.37 151.08 19180 678.81 644.87 741.60 17273 213.94 203.24 233.73 19182 616.19 585.38 673.19 # 17273 155.73 147.94 170.13 19200 1,140.09 1,083.09 1,245.55 17274 257.34 244.47 281.14 19220 1,168.79 1,110.35 1,276.90 # 17274 191.56 181.98 209.28 19240 1,179.64 1,120.66 1,288.76 17276 305.72 290.43 333.99 19260 1,329.41 1,262.94 1,452.38 # 17276 231.79 220.20 253.23 19271 1,878.57 1,784.64 2,052.34 17280 142.51 135.38 155.69 19272 2,052.33 1,949.71 2,242.17 # 17280 95.94 91.14 104.81 19290 219.82 208.83 240.15 17281 182.82 173.68 199.73 # 19290 77.79 73.90 84.99 # 17281 135.09 128.34 147.59 19291 97.02 92.17 106.00 17282 210.63 200.10 230.12 # 19291 38.81 36.87 42.40 # 17282 157.07 149.22 171.60 19295 157.41 149.54 171.97 17283 258.45 245.53 282.36 19296 7,476.31 7,102.49 8,167.86 # 17283 196.75 186.91 214.95 # 19296 245.39 233.12 268.09 17284 304.24 289.03 332.38 19297 111.31 105.74 121.60 # 17284 236.13 224.32 257.97 19298 2,715.54 2,579.76 2,966.72 17286 399.93 379.93 436.92 # 19298 395.27 375.51 431.84 # 17286 328.33 311.91 358.70 19316 911.93 866.33 996.28 17304 796.72 756.88 870.41 19318 1,357.03 1,289.18 1,482.56 # 17304 523.72 497.53 572.16 19324 543.05 515.90 593.29 17305 345.58 328.30 377.55 19325 756.11 718.30 826.05 # 17305 196.56 186.73 214.74 19328 545.40 518.13 595.85 17306 346.74 329.40 378.81 19330 690.92 656.37 754.83 # 17306 197.14 187.28 215.37 19340 464.28 441.07 507.23 17307 326.37 310.05 356.56 19342 1,019.92 968.92 1,114.26 # 17307 197.72 187.83 216.00 19350 1,204.42 1,144.20 1,315.83 17310 133.66 126.98 146.03 # 19350 815.00 774.25 890.39 # 17310 66.13 62.82 72.24 19355 928.10 881.70 1,013.96 17340 53.65 50.97 58.62 # 19355 603.87 573.68 659.73 # 17340 53.07 50.42 57.98 19357 1,719.77 1,633.78 1,878.85 17360 143.43 136.26 156.70 19361 1,578.57 1,499.64 1,724.59 # 17360 110.25 104.74 120.45 19364 3,189.76 3,030.27 3,484.81 19000 151.93 144.33 165.98 19366 1,618.40 1,537.48 1,768.10 # 19000 54.14 51.43 59.14 19367 2,116.70 2,010.87 2,312.50 19001 32.60 30.97 35.62 19368 2,554.22 2,426.51 2,790.49 # 19001 26.20 24.89 28.62 19369 2,393.93 2,274.23 2,615.36 19020 525.30 499.04 573.90 19370 761.00 722.95 831.39 # 19020 311.67 296.09 340.50 19371 875.40 831.63 956.37 19030 231.46 219.89 252.87 19380 855.52 812.74 934.65 # 19030 93.50 88.83 102.15 19396 158.37 150.45 173.02 19100 177.18 168.32 193.57 # 19396 153.13 145.47 167.29 # 19100 79.97 75.97 87.37 20000 249.43 236.96 272.50 19101 401.29 381.23 438.41 # 20000 193.55 183.87 211.45 # 19101 250.52 237.99 273.69 20005 353.54 335.86 386.24 19102 308.25 292.84 336.77 # 20005 281.36 267.29 307.38 # 19102 123.14 116.98 134.53 20100 698.58 663.65 763.20 19103 827.90 786.51 904.49 20101 487.36 462.99 532.44 # 19103 228.91 217.46 250.08 # 20101 235.89 224.10 257.72 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 8 FSY06 LOCALITY FEE SCHEDULE FOR AREA 06 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 607.09 576.74 663.25 20692 505.71 480.42 552.48 # 20102 282.86 268.72 309.03 20693 579.45 550.48 633.05 20103 733.89 697.20 801.78 20694 602.74 572.60 658.49 # 20103 431.19 409.63 471.07 # 20694 421.70 400.62 460.71 20150 1,015.42 964.65 1,109.35 20802 2,986.15 2,836.84 3,262.37 20200 241.90 229.81 264.28 20805 4,150.59 3,943.06 4,534.52 # 20200 108.60 103.17 118.65 20808 5,134.04 4,877.34 5,608.94 20205 330.57 314.04 361.15 20816 3,571.75 3,393.16 3,902.13 # 20205 172.82 164.18 188.81 20822 3,159.51 3,001.53 3,451.76 20206 421.49 400.42 460.48 20824 3,501.17 3,326.11 3,825.03 # 20206 78.63 74.70 85.91 20827 3,290.28 3,125.77 3,594.64 20220 319.60 303.62 349.16 20838 3,009.00 2,858.55 3,287.33 # 20220 99.57 94.59 108.78 20900 741.14 704.08 809.69 20225 1,508.69 1,433.26 1,648.25 # 20900 580.48 551.46 634.18 # 20225 147.15 139.79 160.76 20902 739.74 702.75 808.16 20240 291.02 276.47 317.94 20910 536.63 509.80 586.27 20245 731.29 694.73 798.94 20912 612.72 582.08 669.39 20250 433.15 411.49 473.21 20920 477.73 453.84 521.92 20251 496.27 471.46 542.18 20922 725.41 689.14 792.51 20500 185.06 175.81 202.18 # 20922 569.40 540.93 622.07 # 20500 141.98 134.88 155.11 20924 631.72 600.13 690.15 20501 201.85 191.76 220.52 20926 522.62 496.49 570.96 # 20501 46.43 44.11 50.73 20931 138.15 131.24 150.93 20520 250.29 237.78 273.45 20937 210.93 200.38 230.44 # 20520 183.35 174.18 200.31 20938 229.11 217.65 250.30 20525 688.06 653.66 751.71 20950 455.40 432.63 497.52 # 20525 307.36 291.99 335.79 # 20950 113.71 108.02 124.22 20526 97.84 92.95 106.89 20955 3,127.26 2,970.90 3,416.54 # 20526 71.64 68.06 78.27 20956 3,208.40 3,047.98 3,505.18 20550 74.01 70.31 80.86 20957 2,926.70 2,780.37 3,197.43 # 20550 46.07 43.77 50.34 20962 3,301.46 3,136.39 3,606.85 20551 72.02 68.42 78.68 20969 3,453.92 3,281.22 3,773.40 # 20551 51.64 49.06 56.42 20970 3,389.84 3,220.35 3,703.40 20552 69.96 66.46 76.43 20972 3,075.52 2,921.74 3,360.00 # 20552 39.69 37.71 43.37 20973 3,460.75 3,287.71 3,780.87 20553 79.20 75.24 86.53 20974 68.04 64.64 74.34 # 20553 44.27 42.06 48.37 # 20974 59.31 56.34 64.79 20600 66.61 63.28 72.77 20975 217.62 206.74 237.75 # 20600 49.15 46.69 53.69 20979 73.96 70.26 80.80 20605 73.83 70.14 80.66 # 20979 47.18 44.82 51.54 # 20605 50.54 48.01 55.21 20982 6,707.35 6,371.98 7,327.78 20610 90.09 85.59 98.43 # 20982 485.80 461.51 530.74 # 20610 59.24 56.28 64.72 21010 852.28 809.67 931.12 20612 72.22 68.61 78.90 21015 523.87 497.68 572.33 # 20612 51.84 49.25 56.64 21025 1,155.06 1,097.31 1,261.91 20615 302.46 287.34 330.44 # 21025 986.25 936.94 1,077.48 # 20615 205.25 194.99 224.24 21026 670.04 636.54 732.02 20650 236.15 224.34 257.99 # 21026 580.40 551.38 634.09 # 20650 188.41 178.99 205.84 21029 883.06 838.91 964.75 20660 294.48 279.76 321.72 # 21029 745.10 707.85 814.03 # 20660 210.07 199.57 229.51 21030 565.30 537.04 617.60 20661 512.44 486.82 559.84 # 21030 489.04 464.59 534.28 20662 582.47 553.35 636.35 21031 444.91 422.66 486.06 20663 524.90 498.66 573.46 # 21031 354.68 336.95 387.49 20664 780.45 741.43 852.64 21032 455.14 432.38 497.24 20665 183.61 174.43 200.59 # 21032 348.03 330.63 380.22 # 20665 136.46 129.64 149.09 21034 1,627.76 1,546.37 1,778.33 20670 751.03 713.48 820.50 # 21034 1,437.41 1,365.54 1,570.37 # 20670 200.36 190.34 218.89 21040 568.79 540.35 621.40 20680 662.21 629.10 723.47 # 21040 470.99 447.44 514.56 # 20680 366.50 348.18 400.41 21044 1,055.76 1,002.97 1,153.42 20690 303.71 288.52 331.80 21045 1,414.76 1,344.02 1,545.62 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 06 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 1,267.07 1,203.72 1,384.28 21175 2,502.23 2,377.12 2,733.69 21047 1,597.25 1,517.39 1,745.00 21179 1,796.20 1,706.39 1,962.35 21048 1,299.19 1,234.23 1,419.36 21180 2,004.58 1,904.35 2,190.00 21049 1,529.47 1,453.00 1,670.95 21181 869.55 826.07 949.98 21050 1,023.99 972.79 1,118.71 21182 2,490.64 2,366.11 2,721.03 21060 950.96 903.41 1,038.92 21183 2,758.08 2,620.18 3,013.21 21070 778.25 739.34 850.24 21184 2,971.22 2,822.66 3,246.06 21076 1,314.32 1,248.60 1,435.89 21188 2,054.36 1,951.64 2,244.39 # 21076 1,176.94 1,118.09 1,285.80 21193 1,488.86 1,414.42 1,626.58 21077 3,309.54 3,144.06 3,615.67 21194 1,657.20 1,574.34 1,810.49 # 21077 2,998.69 2,848.76 3,276.07 21195 1,604.55 1,524.32 1,752.97 21079 2,238.52 2,126.59 2,445.58 21196 1,734.10 1,647.40 1,894.51 # 21079 1,984.72 1,885.48 2,168.30 21198 1,351.46 1,283.89 1,476.47 21080 2,539.26 2,412.30 2,774.15 21199 1,215.52 1,154.74 1,327.95 # 21080 2,240.06 2,128.06 2,447.27 21206 1,342.29 1,275.18 1,466.46 21081 2,308.25 2,192.84 2,521.77 21208 1,744.91 1,657.66 1,906.31 # 21081 2,027.68 1,926.30 2,215.25 # 21208 1,000.98 950.93 1,093.57 21082 2,052.04 1,949.44 2,241.86 21209 925.07 878.82 1,010.64 # 21082 1,841.31 1,749.24 2,011.63 # 21209 765.57 727.29 836.38 21083 1,950.03 1,852.53 2,130.41 21210 1,898.43 1,803.51 2,074.04 # 21083 1,695.65 1,610.87 1,852.50 # 21210 992.68 943.05 1,084.51 21084 2,276.66 2,162.83 2,487.25 21215 2,919.03 2,773.08 3,189.04 # 21084 2,000.16 1,900.15 2,185.17 # 21215 1,020.79 969.75 1,115.21 21085 880.05 836.05 961.46 21230 937.55 890.67 1,024.27 # 21085 792.16 752.55 865.43 21235 862.17 819.06 941.92 21086 2,487.56 2,363.18 2,717.66 # 21235 661.92 628.82 723.14 # 21086 2,236.09 2,124.29 2,442.93 21240 1,327.94 1,261.54 1,450.77 21087 2,454.24 2,331.53 2,681.26 21242 1,240.64 1,178.61 1,355.40 # 21087 2,215.58 2,104.80 2,420.52 21243 1,940.41 1,843.39 2,119.90 21088 2,781.77 2,642.68 3,039.08 21244 1,217.83 1,156.94 1,330.48 21100 852.34 809.72 931.18 21245 1,350.84 1,283.30 1,475.80 # 21100 455.93 433.13 498.10 # 21245 1,085.40 1,031.13 1,185.80 21110 787.13 747.77 859.94 21246 1,066.93 1,013.58 1,165.62 # 21110 716.69 680.86 782.99 21247 2,000.40 1,900.38 2,185.44 21116 287.02 272.67 313.57 21248 1,211.97 1,151.37 1,324.08 # 21116 53.60 50.92 58.56 # 21248 1,052.47 999.85 1,149.83 21120 832.21 790.60 909.19 21249 1,747.46 1,660.09 1,909.10 # 21120 651.76 619.17 712.05 # 21249 1,512.29 1,436.68 1,652.18 21121 900.20 855.19 983.47 21255 1,678.16 1,594.25 1,833.39 # 21121 788.43 749.01 861.36 21256 1,383.66 1,314.48 1,511.65 21122 874.90 831.16 955.83 21260 1,439.54 1,367.56 1,572.69 21123 1,117.32 1,061.45 1,220.67 21261 2,775.81 2,637.02 3,032.57 21125 3,673.87 3,490.18 4,013.71 21263 2,331.06 2,214.51 2,546.69 # 21125 935.65 888.87 1,022.20 21267 1,962.81 1,864.67 2,144.37 21127 2,986.58 2,837.25 3,262.84 21268 2,262.15 2,149.04 2,471.40 # 21127 1,040.02 988.02 1,136.22 21270 1,112.51 1,056.88 1,215.41 21137 882.01 837.91 963.60 # 21270 855.81 813.02 934.97 21138 1,093.51 1,038.83 1,194.65 21275 963.65 915.47 1,052.79 21139 1,267.42 1,204.05 1,384.66 21280 600.74 570.70 656.31 21141 1,588.61 1,509.18 1,735.56 21282 409.17 388.71 447.02 21142 1,569.89 1,491.40 1,715.11 21295 213.95 203.25 233.74 21143 1,670.50 1,586.98 1,825.03 21296 467.05 443.70 510.26 21145 1,689.85 1,605.36 1,846.16 21300 170.39 161.87 186.15 21146 1,810.46 1,719.94 1,977.93 # 21300 47.56 45.18 51.96 21147 1,806.99 1,716.64 1,974.14 21310 158.10 150.20 172.73 21150 2,065.00 1,961.75 2,256.01 # 21310 33.53 31.85 36.63 21151 2,544.87 2,417.63 2,780.27 21315 311.61 296.03 340.43 21154 2,648.99 2,516.54 2,894.02 # 21315 174.81 166.07 190.98 21155 2,954.36 2,806.64 3,227.64 21320 307.77 292.38 336.24 21159 3,616.41 3,435.59 3,950.93 # 21320 173.89 165.20 189.98 21160 3,589.31 3,409.84 3,921.32 21325 663.34 630.17 724.70 21172 2,017.53 1,916.65 2,204.15 21330 798.32 758.40 872.16 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 06 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 929.36 882.89 1,015.32 # 21480 37.32 35.45 40.77 21336 806.66 766.33 881.28 21485 653.85 621.16 714.33 21337 473.99 450.29 517.83 # 21485 621.25 590.19 678.72 # 21337 324.97 308.72 355.03 21490 1,094.73 1,039.99 1,195.99 21338 1,100.58 1,045.55 1,202.38 21495 733.41 696.74 801.25 21339 1,163.27 1,105.11 1,270.88 21497 661.71 628.62 722.91 21340 955.12 907.36 1,043.46 # 21497 614.56 583.83 671.40 21343 1,464.23 1,391.02 1,599.67 21501 539.81 512.82 589.74 21344 1,822.91 1,731.76 1,991.52 # 21501 387.88 368.49 423.76 21345 928.23 881.82 1,014.09 21502 641.50 609.43 700.84 # 21345 772.22 733.61 843.65 21510 583.01 553.86 636.94 21346 1,172.43 1,113.81 1,280.88 21550 296.62 281.79 324.06 21347 1,496.15 1,421.34 1,634.54 # 21550 187.76 178.37 205.13 21348 1,385.99 1,316.69 1,514.19 21555 511.95 486.35 559.30 21355 524.95 498.70 573.51 # 21555 376.32 357.50 411.13 # 21355 364.29 346.08 397.99 21556 481.08 457.03 525.58 21356 595.11 565.35 650.15 21557 699.43 664.46 764.13 # 21356 444.93 422.68 486.08 21600 638.45 606.53 697.51 21360 626.56 595.23 684.51 21610 1,185.12 1,125.86 1,294.74 21365 1,280.21 1,216.20 1,398.63 21615 826.07 784.77 902.49 21366 1,442.95 1,370.80 1,576.42 21616 1,001.84 951.75 1,094.51 21385 878.71 834.77 959.99 21620 648.12 615.71 708.07 21386 808.28 767.87 883.05 21627 669.11 635.65 731.00 21387 942.92 895.77 1,030.14 21630 1,458.96 1,386.01 1,593.91 21390 888.11 843.70 970.26 21632 1,449.06 1,376.61 1,583.10 21395 1,076.48 1,022.66 1,176.06 21685 1,135.59 1,078.81 1,240.63 21400 213.07 202.42 232.78 21700 518.09 492.19 566.02 # 21400 170.00 161.50 185.73 21705 750.58 713.05 820.01 21401 608.03 577.63 664.27 21720 396.38 376.56 433.04 # 21401 345.50 328.23 377.46 21725 630.97 599.42 689.33 21406 657.41 624.54 718.22 21740 1,224.41 1,163.19 1,337.67 21407 772.96 734.31 844.46 21750 833.44 791.77 910.54 21408 1,056.14 1,003.33 1,153.83 21800 119.22 113.26 130.25 21421 771.14 732.58 842.47 21805 307.88 292.49 336.36 # 21421 711.18 675.62 776.96 21810 591.20 561.64 645.89 21422 833.40 791.73 910.49 21820 162.45 154.33 177.48 21423 997.12 947.26 1,089.35 # 21820 158.96 151.01 173.66 21431 859.14 816.18 938.61 21825 700.92 665.87 765.75 21432 839.67 797.69 917.34 21920 278.67 264.74 304.45 21433 2,054.09 1,951.39 2,244.10 # 21920 172.73 164.09 188.70 21435 1,489.79 1,415.30 1,627.60 21925 498.24 473.33 544.33 21436 2,276.93 2,163.08 2,487.54 # 21925 385.89 366.60 421.59 21440 533.45 506.78 582.80 21930 552.44 524.82 603.54 # 21440 478.74 454.80 523.02 # 21930 417.39 396.52 456.00 21445 806.55 766.22 881.15 21935 1,350.65 1,283.12 1,475.59 # 21445 725.64 689.36 792.76 22010 1,009.89 959.40 1,103.31 21450 559.52 531.54 611.27 22015 1,001.44 951.37 1,094.08 # 21450 529.83 503.34 578.84 22100 886.33 842.01 968.31 21451 758.90 720.96 829.10 22101 896.81 851.97 979.77 # 21451 703.02 667.87 768.05 22102 917.04 871.19 1,001.87 21452 847.28 804.92 925.66 22103 176.24 167.43 192.54 # 21452 355.99 338.19 388.92 22110 1,119.04 1,063.09 1,222.55 21453 869.72 826.23 950.16 22112 1,122.48 1,066.36 1,226.31 # 21453 869.14 825.68 949.53 22114 1,123.98 1,067.78 1,227.95 21454 647.70 615.32 707.62 22116 174.56 165.83 190.70 21461 1,780.20 1,691.19 1,944.87 22210 1,998.08 1,898.18 2,182.91 # 21461 1,091.57 1,036.99 1,192.54 22212 1,657.70 1,574.82 1,811.04 21462 2,040.30 1,938.29 2,229.03 22214 1,690.60 1,606.07 1,846.98 # 21462 1,170.63 1,112.10 1,278.92 22216 459.22 436.26 501.70 21465 1,092.61 1,037.98 1,193.68 22220 1,785.46 1,696.19 1,950.62 21470 1,371.87 1,303.28 1,498.77 22222 1,623.27 1,542.11 1,773.43 21480 129.87 123.38 141.89 22224 1,805.18 1,714.92 1,972.16 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 06 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 456.90 434.06 499.17 # 23000 451.23 428.67 492.97 22305 227.85 216.46 248.93 23020 841.25 799.19 919.07 # 22305 205.15 194.89 224.12 23030 584.21 555.00 638.25 22310 281.81 267.72 307.88 # 23030 322.27 306.16 352.08 # 22310 255.62 242.84 279.27 23031 581.26 552.20 635.03 22315 969.09 920.64 1,058.74 # 23031 281.47 267.40 307.51 # 22315 831.71 790.12 908.64 23035 867.87 824.48 948.15 22318 1,782.11 1,693.00 1,946.95 23040 871.15 827.59 951.73 22319 1,978.94 1,879.99 2,161.99 23044 694.61 659.88 758.86 22325 1,541.58 1,464.50 1,684.18 23065 242.09 229.99 264.49 22326 1,644.03 1,561.83 1,796.10 # 23065 191.45 181.88 209.16 22327 1,597.72 1,517.83 1,745.50 23066 631.65 600.07 690.08 22328 341.96 324.86 373.59 # 23066 416.27 395.46 454.78 22505 139.48 132.51 152.39 23075 319.05 303.10 348.57 22520 4,003.06 3,802.91 4,373.35 # 23075 209.62 199.14 229.01 # 22520 700.78 665.74 765.60 23076 661.46 628.39 722.65 22521 3,644.84 3,462.60 3,981.99 23077 1,305.97 1,240.67 1,426.77 # 22521 666.20 632.89 727.82 23100 600.04 570.04 655.55 22522 292.51 277.88 319.56 23101 561.17 533.11 613.08 22523 742.77 705.63 811.47 23105 784.27 745.06 856.82 22524 712.59 676.96 778.50 23106 598.89 568.95 654.29 22525 331.92 315.32 362.62 23107 817.54 776.66 893.16 22532 1,944.42 1,847.20 2,124.28 23120 695.71 660.92 760.06 22533 1,808.62 1,718.19 1,975.92 23125 861.90 818.81 941.63 22534 450.81 428.27 492.51 23130 754.29 716.58 824.07 22548 2,106.33 2,001.01 2,301.16 23140 610.95 580.40 667.46 22554 1,584.35 1,505.13 1,730.90 23145 839.56 797.58 917.22 22556 1,917.22 1,821.36 2,094.56 23146 765.73 727.44 836.56 22558 1,757.00 1,669.15 1,919.52 23150 780.37 741.35 852.55 22585 417.73 396.84 456.37 23155 949.71 902.22 1,037.55 22590 1,726.25 1,639.94 1,885.93 23156 819.64 778.66 895.46 22595 1,642.98 1,560.83 1,794.95 23170 657.26 624.40 718.06 22600 1,398.71 1,328.77 1,528.09 23172 671.36 637.79 733.46 22610 1,401.80 1,331.71 1,531.47 23174 914.07 868.37 998.63 22612 1,789.65 1,700.17 1,955.20 23180 907.11 861.75 991.01 22614 490.48 465.96 535.85 23182 863.05 819.90 942.89 22630 1,754.51 1,666.78 1,916.80 23184 964.18 915.97 1,053.37 22632 395.78 375.99 432.39 23190 682.66 648.53 745.81 22800 1,577.39 1,498.52 1,723.30 23195 890.81 846.27 973.21 22802 2,546.44 2,419.12 2,781.99 23200 1,046.49 994.17 1,143.30 22804 2,966.75 2,818.41 3,241.17 23210 1,081.06 1,027.01 1,181.06 22808 2,137.51 2,030.63 2,335.22 23220 1,282.90 1,218.76 1,401.57 22810 2,424.75 2,303.51 2,649.04 23221 1,477.99 1,404.09 1,614.70 22812 2,626.74 2,495.40 2,869.71 23222 1,987.94 1,888.54 2,171.82 22818 2,549.84 2,422.35 2,785.70 23330 295.84 281.05 323.21 22819 2,835.63 2,693.85 3,097.93 # 23330 191.06 181.51 208.74 22830 960.37 912.35 1,049.20 23331 726.86 690.52 794.10 22840 955.39 907.62 1,043.76 23332 1,064.89 1,011.65 1,163.40 22842 956.63 908.80 1,045.12 23350 244.11 231.90 266.69 22843 1,000.90 950.86 1,093.49 # 23350 61.33 58.26 67.00 22844 1,255.80 1,193.01 1,371.96 23395 1,505.84 1,430.55 1,645.13 22845 909.05 863.60 993.14 23397 1,384.81 1,315.57 1,512.91 22846 945.31 898.04 1,032.75 23400 1,193.16 1,133.50 1,303.53 22847 1,042.56 990.43 1,138.99 23405 779.05 740.10 851.12 22848 457.12 434.26 499.40 23406 969.88 921.39 1,059.60 22849 1,530.23 1,453.72 1,671.78 23410 1,106.69 1,051.36 1,209.06 22850 844.17 801.96 922.25 23412 1,173.81 1,115.12 1,282.39 22851 504.70 479.47 551.39 23415 913.17 867.51 997.64 22852 808.16 767.75 882.91 23420 1,228.71 1,167.27 1,342.36 22855 1,263.49 1,200.32 1,380.37 23430 919.98 873.98 1,005.08 22900 441.87 419.78 482.75 23440 951.40 903.83 1,039.40 23000 691.06 656.51 754.99 23450 1,174.81 1,116.07 1,283.48 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 06 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 1,253.29 1,190.63 1,369.22 23931 424.76 403.52 464.05 23460 1,352.21 1,284.60 1,477.29 # 23931 206.47 196.15 225.57 23462 1,311.58 1,246.00 1,432.90 23935 617.85 586.96 675.00 23465 1,363.09 1,294.94 1,489.18 24000 575.83 547.04 629.10 23466 1,300.60 1,235.57 1,420.91 24006 866.80 823.46 946.98 23470 1,483.74 1,409.55 1,620.98 24065 276.14 262.33 301.68 23472 1,786.57 1,697.24 1,951.83 # 24065 190.57 181.04 208.20 23480 1,013.04 962.39 1,106.75 24066 752.39 714.77 821.99 23485 1,179.18 1,120.22 1,288.25 # 24066 471.82 448.23 515.46 23490 1,024.66 973.43 1,119.44 24075 601.57 571.49 657.21 23491 1,261.78 1,198.69 1,378.49 # 24075 371.06 352.51 405.39 23500 259.49 246.52 283.50 24076 562.27 534.16 614.28 # 23500 239.12 227.16 261.23 24077 970.76 922.22 1,060.55 23505 421.71 400.62 460.71 24100 484.34 460.12 529.14 # 23505 388.53 369.10 424.47 24101 620.16 589.15 677.52 23515 714.35 678.63 780.42 24102 758.82 720.88 829.01 23520 262.55 249.42 286.83 24105 417.29 396.43 455.89 # 23520 256.15 243.34 279.84 24110 719.94 683.94 786.53 23525 421.98 400.88 461.01 24115 852.49 809.87 931.35 # 23525 387.06 367.71 422.87 24116 1,058.79 1,005.85 1,156.73 23530 672.26 638.65 734.45 24120 642.42 610.30 701.85 23532 765.62 727.34 836.44 24125 705.84 670.55 771.13 23540 264.77 251.53 289.26 24126 775.40 736.63 847.12 # 23540 235.66 223.88 257.46 24130 630.52 598.99 688.84 23545 385.12 365.86 420.74 24134 951.88 904.29 1,039.93 # 23545 336.80 319.96 367.95 24136 779.36 740.39 851.45 23550 696.24 661.43 760.64 24138 813.43 772.76 888.67 23552 805.83 765.54 880.37 24140 940.92 893.87 1,027.95 23570 275.19 261.43 300.64 24145 808.44 768.02 883.22 # 23570 268.21 254.80 293.02 24147 839.46 797.49 917.11 23575 463.63 440.45 506.52 24149 1,311.44 1,245.87 1,432.75 # 23575 430.45 408.93 470.27 24150 1,178.25 1,119.34 1,287.24 23585 847.13 804.77 925.49 24151 1,367.20 1,298.84 1,493.67 23600 396.21 376.40 432.86 24152 895.24 850.48 978.05 # 23600 338.00 321.10 369.27 24153 811.77 771.18 886.86 23605 577.13 548.27 630.51 24155 1,012.80 962.16 1,106.48 # 23605 516.01 490.21 563.74 24160 751.71 714.12 821.24 23615 934.78 888.04 1,021.25 24164 614.91 584.16 671.78 23616 1,778.49 1,689.57 1,943.01 24200 275.49 261.72 300.98 23620 318.00 302.10 347.42 # 24200 171.30 162.74 187.15 # 23620 281.33 267.26 307.35 24201 775.25 736.49 846.96 23625 463.77 440.58 506.67 # 24201 449.27 426.81 490.83 # 23625 425.35 404.08 464.69 24220 267.09 253.74 291.80 23630 716.33 680.51 782.59 # 24220 80.82 76.78 88.30 23650 364.75 346.51 398.49 24300 501.37 476.30 547.75 # 23650 305.95 290.65 334.25 24301 931.49 884.92 1,017.66 23655 445.46 423.19 486.67 24305 722.15 686.04 788.95 23660 707.95 672.55 773.43 24310 591.99 562.39 646.75 23665 509.98 484.48 557.15 24320 909.98 864.48 994.15 # 23665 473.89 450.20 517.73 24330 888.58 844.15 970.77 23670 752.52 714.89 822.12 24331 981.55 932.47 1,072.34 23675 668.81 635.37 730.68 24332 727.58 691.20 794.88 # 23675 610.60 580.07 667.08 24340 760.84 722.80 831.22 23680 923.90 877.71 1,009.37 24341 815.97 775.17 891.45 23700 240.03 228.03 262.23 24342 972.96 924.31 1,062.96 23800 1,239.62 1,177.64 1,354.29 24343 861.55 818.47 941.24 23802 1,333.34 1,266.67 1,456.67 24344 1,297.97 1,233.07 1,418.03 23900 1,561.07 1,483.02 1,705.47 24345 854.22 811.51 933.24 23920 1,232.06 1,170.46 1,346.03 24346 1,286.76 1,222.42 1,405.78 23921 538.02 511.12 587.79 24350 560.13 532.12 611.94 23930 499.02 474.07 545.18 24351 610.39 579.87 666.85 # 23930 265.01 251.76 289.52 24352 648.61 616.18 708.61 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 06 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 648.17 615.76 708.12 24800 1,004.60 954.37 1,097.53 24356 666.58 633.25 728.24 24802 1,219.24 1,158.28 1,332.02 24360 1,103.62 1,048.44 1,205.71 24900 839.15 797.19 916.77 24361 1,242.14 1,180.03 1,357.03 24920 831.66 790.08 908.59 24362 1,257.88 1,194.99 1,374.24 24925 669.78 636.29 731.73 24363 1,623.94 1,542.74 1,774.15 24930 879.04 835.09 960.35 24365 795.19 755.43 868.74 24931 896.33 851.51 979.24 24366 847.74 805.35 926.15 24935 1,151.51 1,093.93 1,258.02 24400 1,012.34 961.72 1,105.98 25000 551.43 523.86 602.44 24410 1,265.96 1,202.66 1,383.06 25001 397.17 377.31 433.91 24420 1,213.55 1,152.87 1,325.80 25020 821.08 780.03 897.03 24430 1,142.33 1,085.21 1,247.99 25023 1,447.35 1,374.98 1,581.23 24435 1,224.78 1,163.54 1,338.07 25024 854.83 812.09 933.90 24470 841.39 799.32 919.22 25025 1,297.95 1,233.05 1,418.01 24495 868.87 825.43 949.24 25028 708.86 673.42 774.43 24498 1,074.56 1,020.83 1,173.95 25031 645.39 613.12 705.09 24500 425.54 404.26 464.90 25035 1,122.32 1,066.20 1,226.13 # 24500 357.44 339.57 390.51 25040 745.51 708.23 814.46 24505 616.73 585.89 673.77 25065 272.57 258.94 297.78 # 24505 546.30 518.99 596.84 # 25065 195.74 185.95 213.84 24515 1,069.60 1,016.12 1,168.54 25066 595.17 565.41 650.22 24516 1,053.88 1,001.19 1,151.37 25075 509.02 483.57 556.11 24530 459.58 436.60 502.09 25076 774.66 735.93 846.32 # 24530 391.47 371.90 427.69 25077 1,136.37 1,079.55 1,241.48 24535 765.07 726.82 835.84 25085 659.45 626.48 720.45 # 24535 694.05 659.35 758.25 25100 480.40 456.38 524.84 24538 930.95 884.40 1,017.06 25101 552.49 524.87 603.60 24545 961.65 913.57 1,050.61 25105 685.86 651.57 749.31 24546 1,364.01 1,295.81 1,490.18 25107 771.68 733.10 843.07 24560 385.88 366.59 421.58 25110 585.56 556.28 639.72 # 24560 310.79 295.25 339.54 25111 424.45 403.23 463.71 24565 634.14 602.43 692.79 25112 507.52 482.14 554.46 # 24565 570.69 542.16 623.48 25115 1,209.00 1,148.55 1,320.83 24566 824.01 782.81 900.23 25116 1,082.81 1,028.67 1,182.97 24575 967.84 919.45 1,057.37 25118 529.06 502.61 578.00 24576 405.10 384.85 442.58 25119 712.02 676.42 777.88 # 24576 343.98 326.78 375.80 25120 977.37 928.50 1,067.78 24577 662.61 629.48 723.90 25125 1,079.18 1,025.22 1,179.00 # 24577 599.16 569.20 654.58 25126 1,097.01 1,042.16 1,198.48 24579 1,035.55 983.77 1,131.34 25130 607.74 577.35 663.95 24582 915.16 869.40 999.81 25135 742.79 705.65 811.50 24586 1,337.07 1,270.22 1,460.75 25136 652.07 619.47 712.39 24587 1,319.91 1,253.91 1,442.00 25145 986.85 937.51 1,078.14 24600 467.20 443.84 510.42 25150 794.58 754.85 868.08 # 24600 388.03 368.63 423.92 25151 1,071.44 1,017.87 1,170.55 24605 554.72 526.98 606.03 25170 1,377.23 1,308.37 1,504.63 24615 877.77 833.88 958.96 25210 659.27 626.31 720.26 24620 674.32 640.60 736.69 25215 860.34 817.32 939.92 24635 1,410.95 1,340.40 1,541.46 25230 589.97 560.47 644.54 24640 159.39 151.42 174.13 25240 635.17 603.41 693.92 # 24640 98.27 93.36 107.36 25246 261.97 248.87 286.20 24650 316.93 301.08 346.24 # 25246 89.08 84.63 97.32 # 24650 256.97 244.12 280.74 25248 723.16 687.00 790.05 24655 542.98 515.83 593.20 25250 648.68 616.25 708.69 # 24655 474.88 451.14 518.81 25251 881.45 837.38 962.99 24665 803.07 762.92 877.36 25259 501.23 476.17 547.60 24666 895.65 850.87 978.50 25260 1,122.70 1,066.57 1,226.56 24670 353.04 335.39 385.70 25263 1,120.36 1,064.34 1,223.99 # 24670 292.50 277.88 319.56 25265 1,272.27 1,208.66 1,389.96 24675 561.57 533.49 613.51 25270 968.60 920.17 1,058.20 # 24675 501.03 475.98 547.38 25272 1,059.59 1,006.61 1,157.60 24685 833.15 791.49 910.21 25274 1,183.49 1,124.32 1,292.97 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 06 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 819.36 778.39 895.15 # 25560 259.63 246.65 283.65 25280 1,056.87 1,004.03 1,154.63 25565 642.23 610.12 701.64 25290 1,109.47 1,054.00 1,212.10 # 25565 567.72 539.33 620.23 25295 999.75 949.76 1,092.22 25574 734.23 697.52 802.15 25300 880.99 836.94 962.48 25575 1,023.29 972.13 1,117.95 25301 842.75 800.61 920.70 25600 355.78 337.99 388.69 25310 1,120.71 1,064.67 1,224.37 # 25600 290.58 276.05 317.46 25312 1,236.68 1,174.85 1,351.08 25605 682.09 647.99 745.19 25315 1,292.78 1,228.14 1,412.36 # 25605 623.30 592.14 680.96 25316 1,489.80 1,415.31 1,627.61 25611 871.32 827.75 951.91 25320 1,140.89 1,083.85 1,246.43 25620 805.43 765.16 879.93 25332 1,043.02 990.87 1,139.50 25622 365.20 346.94 398.98 25335 1,245.84 1,183.55 1,361.08 # 25622 297.10 282.25 324.59 25337 1,098.45 1,043.53 1,200.06 25624 570.10 541.60 622.84 25350 1,207.51 1,147.13 1,319.20 # 25624 497.92 473.02 543.97 25355 1,307.42 1,242.05 1,428.36 25628 831.94 790.34 908.89 25360 1,186.25 1,126.94 1,295.98 25630 371.91 353.31 406.31 25365 1,468.81 1,395.37 1,604.68 # 25630 299.73 284.74 327.45 25370 1,536.03 1,459.23 1,678.11 25635 542.96 515.81 593.18 25375 1,542.90 1,465.76 1,685.62 # 25635 423.63 402.45 462.82 25390 1,313.09 1,247.44 1,434.56 25645 710.57 675.04 776.30 25391 1,574.06 1,495.36 1,719.66 25650 386.39 367.07 422.13 25392 1,549.26 1,471.80 1,692.57 # 25650 320.03 304.03 349.63 25393 1,737.61 1,650.73 1,898.34 25651 558.54 530.61 610.20 25394 930.94 884.39 1,017.05 25652 746.58 709.25 815.64 25400 1,373.86 1,305.17 1,500.95 25660 481.95 457.85 526.53 25405 1,648.32 1,565.90 1,800.79 25670 760.71 722.67 831.07 25415 1,558.57 1,480.64 1,702.74 25671 626.95 595.60 684.94 25420 1,792.85 1,703.21 1,958.69 25675 534.56 507.83 584.00 25425 1,835.35 1,743.58 2,005.12 # 25675 475.77 451.98 519.78 25426 1,670.30 1,586.79 1,824.81 25676 785.08 745.83 857.70 25430 834.92 793.17 912.15 25680 538.56 511.63 588.37 25431 959.86 911.87 1,048.65 25685 891.24 846.68 973.68