1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 1 FSY06 LOCALITY FEE SCHEDULE FOR AREA 09 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 158.98 151.03 173.68 D0421 9.26 8.80 10.12 G0182 169.49 161.02 185.17 D0431 9.26 8.80 10.12 G0186 366.43 348.11 400.33 D0475 22.94 21.79 25.06 G0202 193.27 183.61 211.15 D0476 106.75 101.41 116.62 G0202 TC 150.43 142.91 164.35 D0477 79.38 75.41 86.72 G0202 26 42.84 40.70 46.81 D0478 139.19 132.23 152.06 G0204 201.06 191.01 219.66 D0479 167.79 159.40 183.31 G0204 TC 148.09 140.69 161.79 D0481 581.72 552.63 635.52 G0204 26 52.96 50.31 57.86 D0482 122.98 116.83 134.35 G0206 162.69 154.56 177.74 D0483 105.83 100.54 115.62 G0206 TC 119.85 113.86 130.94 D0484 97.72 92.83 106.75 G0206 26 42.84 40.70 46.81 # D0484 84.99 80.74 92.85 G0237 27.89 26.50 30.48 D0485 154.99 147.24 169.33 G0238 29.06 27.61 31.75 D7288 187.95 178.55 205.33 G0239 19.72 18.73 21.54 # D7288 123.22 117.06 134.62 G0245 83.14 78.98 90.83 D7321 403.52 383.34 440.84 # G0245 55.13 52.37 60.23 # D7321 311.12 295.56 339.89 G0246 50.44 47.92 55.11 D7511 332.40 315.78 363.15 # G0246 28.27 26.86 30.89 # D7511 261.58 248.50 285.78 G0247 51.33 48.76 56.07 D7521 198.63 188.70 217.01 # G0247 33.24 31.58 36.32 # D7521 121.15 115.09 132.35 G0248 387.17 367.81 422.98 G0101 49.28 46.82 53.84 G0249 231.93 220.33 253.38 # G0101 28.85 27.41 31.52 G0250 11.12 10.56 12.14 G0102 29.97 28.47 32.74 G0268 62.26 59.15 68.02 # G0102 10.71 10.17 11.70 # G0268 39.50 37.53 43.16 G0104 174.30 165.59 190.43 G0270 27.66 26.28 30.22 # G0104 70.41 66.89 76.92 G0271 10.73 10.19 11.72 G0105 517.83 491.94 565.73 G0275 16.33 15.51 17.84 # G0105 244.11 231.90 266.69 G0278 16.33 15.51 17.84 G0105 53 174.30 165.59 190.43 G0281 14.04 13.34 15.34 # G0105 53 70.41 66.89 76.92 G0283 14.04 13.34 15.34 G0106 193.93 184.23 211.86 G0288 625.09 593.84 682.92 G0106 TC 133.71 127.02 146.07 G0289 113.38 107.71 123.87 G0106 26 60.22 57.21 65.79 G0308 1,032.08 980.48 1,127.55 G0108 48.67 46.24 53.18 G0309 859.25 816.29 938.73 G0109 28.24 26.83 30.85 G0310 687.53 653.15 751.12 G0117 60.72 57.68 66.33 G0311 683.18 649.02 746.37 # G0117 29.79 28.30 32.55 G0312 568.86 540.42 621.48 G0118 38.14 36.23 41.66 G0313 455.25 432.49 497.36 # G0118 10.71 10.17 11.70 G0314 604.56 574.33 660.48 G0120 193.93 184.23 211.86 G0315 503.23 478.07 549.78 G0120 TC 133.71 127.02 146.07 G0316 402.62 382.49 439.86 G0120 26 60.22 57.21 65.79 G0317 380.30 361.29 415.48 G0121 517.83 491.94 565.73 G0318 316.71 300.87 346.00 # G0121 244.11 231.90 266.69 G0319 253.13 240.47 276.54 G0121 53 174.30 165.59 190.43 G0320 859.25 816.29 938.73 # G0121 53 70.41 66.89 76.92 G0321 568.86 540.42 621.48 G0124 26.45 25.13 28.90 G0322 503.23 478.07 549.78 G0127 21.80 20.71 23.82 G0323 316.71 300.87 346.00 # G0127 11.29 10.73 12.34 G0324 28.60 27.17 31.25 G0128 5.26 5.00 5.75 G0325 16.67 15.84 18.22 G0130 61.18 58.12 66.84 G0326 18.90 17.96 20.65 G0130 TC 47.83 45.44 52.26 G0327 10.64 10.11 11.63 G0130 26 13.34 12.67 14.57 G0329 10.86 10.32 11.87 G0141 26.45 25.13 28.90 # G0329 3.86 3.67 4.22 G0166 212.04 201.44 231.66 G0332 111.47 105.90 121.79 # G0166 4.85 4.61 5.30 G0341 633.05 601.40 691.61 G0168 132.38 125.76 144.62 # G0341 449.21 426.75 490.76 # G0168 32.00 30.40 34.96 G0342 832.56 790.93 909.57 G0179 79.04 75.09 86.35 G0343 1,374.28 1,305.57 1,501.41 G0180 101.72 96.63 111.12 G0344 123.24 117.08 134.64 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 09 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 85.30 81.04 93.20 11006 830.49 788.97 907.32 G0364 15.65 14.87 17.10 11008 337.65 320.77 368.89 # G0364 10.98 10.43 11.99 11010 589.19 559.73 643.69 G0365 249.43 236.96 272.50 # 11010 340.57 323.54 372.07 G0365 TC 233.46 221.79 255.06 11011 697.09 662.24 761.58 G0365 26 15.97 15.17 17.45 # 11011 356.84 339.00 389.85 G0366 37.43 35.56 40.89 11012 1,017.03 966.18 1,111.11 G0367 26.72 25.38 29.19 # 11012 533.21 506.55 582.53 G0368 10.71 10.17 11.70 11040 52.24 49.63 57.07 G0372 29.97 28.47 32.74 # 11040 34.15 32.44 37.31 # G0372 10.71 10.17 11.70 11041 74.46 70.74 81.35 G0375 15.33 14.56 16.74 # 11041 55.20 52.44 60.31 G0376 30.43 28.91 33.25 11042 105.56 100.28 115.32 # G0376 29.85 28.36 32.61 # 11042 74.62 70.89 81.52 M0064 35.26 33.50 38.53 11043 302.85 287.71 330.87 # M0064 22.42 21.30 24.50 # 11043 256.75 243.91 280.50 P3001 26.45 25.13 28.90 11044 395.73 375.94 432.33 Q0035 33.93 32.23 37.06 # 11044 354.88 337.14 387.71 Q0035 TC 23.22 22.06 25.37 11055 51.48 48.91 56.25 Q0035 26 10.71 10.17 11.70 # 11055 28.71 27.27 31.36 Q0091 54.75 52.01 59.81 11056 63.99 60.79 69.91 # Q0091 23.81 22.62 26.01 # 11056 40.06 38.06 43.77 Q0092 18.90 17.96 20.65 11057 77.90 74.01 85.11 R0070 174.06 165.36 190.16 # 11057 52.22 49.61 57.05 R0075 174.06 165.36 190.16 11100 106.88 101.54 116.77 0016T 366.43 348.11 400.33 # 11100 55.53 52.75 60.66 0024T 704.34 669.12 769.49 11101 36.54 34.71 39.92 0030T 26.18 24.87 28.60 # 11101 28.37 26.95 30.99 0067T 592.21 562.60 646.99 11200 93.22 88.56 101.84 0067T TC 520.03 494.03 568.13 # 11200 76.87 73.03 83.98 0067T 26 72.18 68.57 78.86 11201 21.70 20.62 23.71 0073T 1,057.58 1,004.70 1,155.41 # 11201 19.36 18.39 21.15 10021 180.48 171.46 197.18 11300 79.40 75.43 86.74 # 10021 85.93 81.63 93.87 # 11300 33.87 32.18 37.01 10022 202.78 192.64 221.54 11301 100.58 95.55 109.88 # 10022 78.47 74.55 85.73 # 11301 57.98 55.08 63.34 10040 108.52 103.09 118.55 11302 120.11 114.10 131.22 # 10040 95.68 90.90 104.54 # 11302 71.09 67.54 77.67 10060 121.39 115.32 132.62 11303 144.71 137.47 158.09 # 10060 105.04 99.79 114.76 # 11303 82.84 78.70 90.51 10061 211.26 200.70 230.81 11305 78.71 74.77 85.99 # 10061 192.00 182.40 209.76 # 11305 44.86 42.62 49.01 10080 232.04 220.44 253.51 11306 106.43 101.11 116.28 # 10080 115.32 109.55 125.98 # 11306 66.75 63.41 72.92 10081 344.17 326.96 376.00 11307 123.68 117.50 135.13 # 10081 193.59 183.91 211.50 # 11307 76.99 73.14 84.11 10120 180.05 171.05 196.71 11308 145.47 138.20 158.93 # 10120 109.43 103.96 119.55 # 11308 95.28 90.52 104.10 10121 323.39 307.22 353.30 11310 95.66 90.88 104.51 # 10121 222.43 211.31 243.01 # 11310 49.55 47.07 54.13 10140 171.03 162.48 186.85 11311 116.03 110.23 126.76 # 10140 142.43 135.31 155.61 # 11311 72.84 69.20 79.58 10160 145.84 138.55 159.33 11312 133.50 126.83 145.85 # 10160 115.49 109.72 126.18 # 11312 82.72 78.58 90.37 10180 274.86 261.12 300.29 11313 174.41 165.69 190.54 # 10180 216.50 205.68 236.53 # 11313 110.80 105.26 121.05 11000 60.08 57.08 65.64 11400 152.98 145.33 167.13 # 11000 39.07 37.12 42.69 # 11400 87.62 83.24 95.73 11001 26.65 25.32 29.12 11401 173.00 164.35 189.00 # 11001 19.65 18.67 21.47 # 11401 112.30 106.69 122.69 11004 666.69 633.36 728.36 11402 195.10 185.35 213.15 11005 911.98 866.38 996.34 # 11402 127.98 121.58 139.82 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 3 FSY06 LOCALITY FEE SCHEDULE FOR AREA 09 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 217.43 206.56 237.54 11624 350.63 333.10 383.07 # 11403 154.40 146.68 168.68 # 11624 235.66 223.88 257.46 11404 247.52 235.14 270.41 11626 457.18 434.32 499.47 # 11404 171.06 162.51 186.89 # 11626 326.44 310.12 356.64 11406 299.78 284.79 327.51 11640 213.17 202.51 232.89 # 11406 216.90 206.06 236.97 # 11640 122.71 116.57 134.06 11420 145.58 138.30 159.05 11641 269.15 255.69 294.04 # 11420 96.56 91.73 105.49 # 11641 181.61 172.53 198.41 11421 182.07 172.97 198.92 11642 309.67 294.19 338.32 # 11421 126.04 119.74 137.70 # 11642 210.45 199.93 229.92 11422 202.46 192.34 221.19 11643 355.54 337.76 388.42 # 11422 148.18 140.77 161.89 # 11643 248.16 235.75 271.11 11423 238.23 226.32 260.27 11644 447.18 424.82 488.54 # 11423 171.70 163.12 187.59 # 11644 317.03 301.18 346.36 11424 269.45 255.98 294.38 11646 594.51 564.78 649.50 # 11424 198.84 188.90 217.24 # 11646 460.86 437.82 503.49 11426 368.49 350.07 402.58 11719 22.03 20.93 24.07 # 11426 287.95 273.55 314.58 # 11719 11.52 10.94 12.58 11440 174.32 165.60 190.44 11720 33.89 32.20 37.03 # 11440 121.79 115.70 133.06 # 11720 21.05 20.00 23.00 11441 200.29 190.28 218.82 11721 49.44 46.97 54.02 # 11441 150.68 143.15 164.62 # 11721 36.02 34.22 39.35 11442 223.08 211.93 243.72 11730 109.70 104.22 119.85 # 11442 165.88 157.59 181.23 # 11730 74.68 70.95 81.59 11443 269.44 255.97 294.37 11732 50.68 48.15 55.37 # 11443 205.24 194.98 224.23 # 11732 37.84 35.95 41.34 11444 338.84 321.90 370.19 11740 48.20 45.79 52.66 # 11444 263.56 250.38 287.94 # 11740 36.53 34.70 39.91 11446 430.08 408.58 469.87 11750 208.02 197.62 227.26 # 11446 355.96 338.16 388.88 # 11750 184.09 174.89 201.12 11450 413.98 393.28 452.27 11752 292.68 278.05 319.76 # 11450 238.31 226.39 260.35 11755 148.60 141.17 162.35 11451 560.20 532.19 612.02 # 11755 101.91 96.81 111.33 # 11451 322.66 306.53 352.51 11760 223.15 211.99 243.79 11462 409.16 388.70 447.01 # 11760 174.12 165.41 190.22 # 11462 228.23 216.82 249.34 11762 295.52 280.74 322.85 11463 573.27 544.61 626.30 # 11762 264.01 250.81 288.43 # 11463 331.06 314.51 361.69 11765 134.62 127.89 147.07 11470 438.44 416.52 479.00 # 11765 74.51 70.78 81.40 # 11470 275.03 261.28 300.47 11770 318.36 302.44 347.81 11471 586.06 556.76 640.27 # 11770 202.22 192.11 220.93 # 11471 355.53 337.75 388.41 11771 582.44 553.32 636.32 11600 210.13 199.62 229.56 # 11771 445.88 423.59 487.13 # 11600 112.67 107.04 123.10 11772 745.33 708.06 814.27 11601 234.79 223.05 256.51 # 11772 602.92 572.77 658.69 # 11601 147.83 140.44 161.51 11900 59.74 56.75 65.26 11602 247.95 235.55 270.88 # 11900 34.06 32.36 37.21 # 11602 156.32 148.50 170.78 11901 72.04 68.44 78.71 11603 273.30 259.64 298.59 # 11901 53.95 51.25 58.94 # 11603 171.17 162.61 187.00 11920 288.10 273.70 314.76 11604 300.35 285.33 328.13 # 11920 135.19 128.43 147.69 # 11604 184.20 174.99 201.24 11921 317.55 301.67 346.92 11606 386.14 366.83 421.85 # 11921 159.97 151.97 174.77 # 11606 250.16 237.65 273.30 11922 88.25 83.84 96.42 11620 202.64 192.51 221.39 # 11922 36.30 34.49 39.66 # 11620 106.35 101.03 116.18 11950 102.38 97.26 111.85 11621 233.14 221.48 254.70 # 11950 58.61 55.68 64.03 # 11621 147.35 139.98 160.98 11951 138.32 131.40 151.11 11622 262.32 249.20 286.58 # 11951 81.12 77.06 88.62 # 11622 170.11 161.60 185.84 11952 181.58 172.50 198.38 11623 306.63 291.30 335.00 # 11952 112.71 107.07 123.13 # 11623 203.91 193.71 222.77 11954 224.64 213.41 245.42 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 09 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 134.18 127.47 146.59 # 12045 292.02 277.42 319.03 11960 1,010.38 959.86 1,103.84 12046 566.90 538.56 619.34 11970 672.31 638.69 734.49 # 12046 347.46 330.09 379.60 11971 628.18 596.77 686.29 12047 574.90 546.16 628.08 # 11971 316.52 300.69 345.79 # 12047 384.05 364.85 419.58 11976 178.25 169.34 194.74 12051 297.38 282.51 324.89 # 11976 117.55 111.67 128.42 # 12051 190.58 181.05 208.21 11980 126.75 120.41 138.47 12052 306.09 290.79 334.41 # 11980 95.23 90.47 104.04 # 12052 201.04 190.99 219.64 11981 162.71 154.57 177.76 12053 323.00 306.85 352.88 # 11981 103.18 98.02 112.72 # 12053 222.61 211.48 243.20 11982 190.75 181.21 208.39 12054 356.82 338.98 389.83 # 11982 125.39 119.12 136.99 # 12054 243.60 231.42 266.13 11983 274.36 260.64 299.74 12055 453.76 431.07 495.73 # 11983 226.50 215.18 247.46 # 12055 316.02 300.22 345.25 12001 189.35 179.88 206.86 12056 623.27 592.11 680.93 # 12001 118.15 112.24 129.08 # 12056 406.75 386.41 444.37 12002 199.87 189.88 218.36 12057 615.95 585.15 672.92 # 12002 132.76 126.12 145.04 # 12057 476.47 452.65 520.55 12004 232.73 221.09 254.25 13100 370.96 352.41 405.27 # 12004 155.69 147.91 170.10 # 13100 268.82 255.38 293.69 12005 288.73 274.29 315.43 13101 438.98 417.03 479.58 # 12005 193.60 183.92 211.51 # 13101 323.42 307.25 353.34 12006 356.66 338.83 389.65 13102 122.15 116.04 133.45 # 12006 246.36 234.04 269.15 # 13102 87.14 82.78 95.20 12007 402.51 382.38 439.74 13120 383.60 364.42 419.08 # 12007 285.21 270.95 311.59 # 13120 278.54 264.61 304.30 12011 200.79 190.75 219.36 13121 466.67 443.34 509.84 # 12011 121.42 115.35 132.65 # 13121 346.44 329.12 378.49 12013 218.86 207.92 239.11 13122 150.66 143.13 164.60 # 12013 140.07 133.07 153.03 # 13122 99.30 94.34 108.49 12014 256.80 243.96 280.55 13131 416.14 395.33 454.63 # 12014 168.09 159.69 183.64 # 13131 318.09 302.19 347.52 12015 320.82 304.78 350.50 13132 596.62 566.79 651.81 # 12015 210.52 199.99 229.99 # 13132 494.49 469.77 540.24 12016 377.13 358.27 412.01 13133 190.89 181.35 208.55 # 12016 258.07 245.17 281.95 # 13133 154.12 146.41 168.37 12017 314.55 298.82 343.64 13150 448.55 426.12 490.04 12018 373.11 354.45 407.62 # 13150 325.41 309.14 355.51 12020 337.93 321.03 369.18 13151 470.05 446.55 513.53 # 12020 227.04 215.69 248.04 # 13151 373.17 354.51 407.69 12021 187.82 178.43 205.19 13152 621.64 590.56 679.14 # 12021 163.30 155.14 178.41 # 13152 504.91 479.66 551.61 12031 225.78 214.49 246.66 13153 216.40 205.58 236.42 # 12031 148.16 140.75 161.86 # 13153 169.71 161.22 185.40 12032 329.73 313.24 360.23 13160 883.60 839.42 965.33 # 12032 210.09 199.59 229.53 14000 714.15 678.44 780.21 12034 312.33 296.71 341.22 # 14000 574.66 545.93 627.82 # 12034 210.19 199.68 229.63 14001 916.93 871.08 1,001.74 12035 453.36 430.69 495.29 # 14001 779.78 740.79 851.91 # 12035 275.36 261.59 300.83 14020 788.38 748.96 861.30 12036 503.48 478.31 550.06 # 14020 666.98 633.63 728.67 # 12036 327.23 310.87 357.50 14021 1,014.82 964.08 1,108.69 12037 562.96 534.81 615.03 # 14021 915.02 869.27 999.66 # 12037 379.70 360.72 414.83 14040 852.13 809.52 930.95 12041 250.44 237.92 273.61 # 14040 758.16 720.25 828.29 # 12041 167.57 159.19 183.07 14041 1,107.28 1,051.92 1,209.71 12042 307.19 291.83 335.60 # 14041 995.22 945.46 1,087.28 # 12042 201.56 191.48 220.20 14060 878.19 834.28 959.42 12044 322.98 306.83 352.85 # 14060 798.82 758.88 872.71 # 12044 228.43 217.01 249.56 14061 1,199.75 1,139.76 1,310.72 12045 466.52 443.19 509.67 # 14061 1,077.19 1,023.33 1,176.83 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 09 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 1,159.72 1,101.73 1,266.99 # 15221 85.19 80.93 93.07 # 14300 1,045.33 993.06 1,142.02 15240 988.72 939.28 1,080.17 14350 842.56 800.43 920.49 # 15240 856.82 813.98 936.08 15000 397.90 378.01 434.71 15241 224.59 213.36 245.36 # 15000 303.94 288.74 332.05 # 15241 134.71 127.97 147.17 15001 123.04 116.89 134.42 15260 1,025.49 974.22 1,120.35 # 15001 68.18 64.77 74.49 # 15260 929.78 883.29 1,015.78 15040 354.29 336.58 387.07 15261 253.91 241.21 277.39 # 15040 153.53 145.85 167.73 # 15261 178.04 169.14 194.51 15050 593.57 563.89 648.47 15300 362.32 344.20 395.83 # 15050 487.94 463.54 533.07 # 15300 305.71 290.42 333.98 15100 1,136.86 1,080.02 1,242.02 15301 71.68 68.10 78.32 # 15100 857.89 815.00 937.25 # 15301 67.59 64.21 73.84 15101 294.36 279.64 321.59 15320 418.03 397.13 456.70 # 15101 144.37 137.15 157.72 # 15320 354.42 336.70 387.21 15110 1,044.37 992.15 1,140.97 15321 106.64 101.31 116.51 # 15110 829.60 788.12 906.34 # 15321 100.81 95.77 110.14 15111 157.17 149.31 171.71 15330 361.74 343.65 395.20 # 15111 127.99 121.59 139.83 # 15330 305.13 289.87 333.35 15115 968.81 920.37 1,058.43 15331 71.09 67.54 77.67 # 15115 859.08 816.13 938.55 # 15331 67.59 64.21 73.84 15116 202.37 192.25 221.09 15335 400.38 380.36 437.41 # 15116 175.53 166.75 191.76 # 15335 340.27 323.26 371.75 15120 1,056.99 1,004.14 1,154.76 15336 103.54 98.36 113.11 # 15120 884.82 840.58 966.67 # 15336 96.54 91.71 105.47 15121 381.04 361.99 416.29 15340 396.10 376.30 432.75 # 15121 225.80 214.51 246.69 # 15340 323.14 306.98 353.03 15130 886.71 842.37 968.73 15341 57.50 54.63 62.82 # 15130 680.69 646.66 743.66 # 15341 33.57 31.89 36.67 15131 128.82 122.38 140.74 15360 430.14 408.63 469.92 # 15131 103.72 98.53 113.31 # 15360 349.02 331.57 381.31 15135 1,036.89 985.05 1,132.81 15361 84.25 80.04 92.05 # 15135 934.76 888.02 1,021.22 # 15361 77.25 73.39 84.40 15136 118.08 112.18 129.01 15365 446.99 424.64 488.34 # 15136 105.25 99.99 114.99 # 15365 367.62 349.24 401.63 15150 859.61 816.63 939.12 15366 104.26 99.05 113.91 # 15150 741.72 704.63 810.32 # 15366 97.25 92.39 106.25 15151 164.95 156.70 180.21 15400 409.14 388.68 446.98 # 15151 138.10 131.20 150.88 15401 155.14 147.38 169.49 15152 201.66 191.58 220.32 # 15401 69.93 66.43 76.39 # 15152 172.48 163.86 188.44 15420 476.15 452.34 520.19 15155 850.98 808.43 929.69 # 15420 418.37 397.45 457.07 # 15155 800.79 760.75 874.86 15421 143.41 136.24 156.68 15156 212.15 201.54 231.77 # 15421 102.56 97.43 112.04 # 15156 193.48 183.81 211.38 15430 654.97 622.22 715.55 15157 235.94 224.14 257.76 # 15430 638.05 606.15 697.07 # 15157 210.85 200.31 230.36 15570 1,069.51 1,016.03 1,168.43 15170 441.92 419.82 482.79 # 15570 803.96 763.76 878.32 # 15170 356.12 338.31 389.06 15572 963.13 914.97 1,052.22 15171 107.65 102.27 117.61 # 15572 785.13 745.87 857.75 # 15171 104.15 98.94 113.78 15574 1,057.62 1,004.74 1,155.45 15175 623.56 592.38 681.24 # 15574 888.37 843.95 970.54 # 15175 540.10 513.10 590.07 15576 946.95 899.60 1,034.54 15176 171.98 163.38 187.89 # 15576 778.87 739.93 850.92 # 15176 164.97 156.72 180.23 15600 529.29 502.83 578.25 15200 901.95 856.85 985.38 # 15600 263.74 250.55 288.13 # 15200 714.61 678.88 780.71 15610 381.64 362.56 416.94 15201 208.52 198.09 227.80 # 15610 307.52 292.14 335.96 # 15201 94.71 89.97 103.47 15620 583.90 554.71 637.92 15220 879.34 835.37 960.68 # 15620 355.71 337.92 388.61 # 15220 732.85 696.21 800.64 15630 554.03 526.33 605.28 15221 188.49 179.07 205.93 # 15630 384.78 365.54 420.37 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 6 FSY06 LOCALITY FEE SCHEDULE FOR AREA 09 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 590.02 560.52 644.60 # 15839 786.60 747.27 859.36 # 15650 418.43 397.51 457.14 15840 1,157.25 1,099.39 1,264.30 15732 1,832.30 1,740.69 2,001.79 15841 1,888.75 1,794.31 2,063.46 # 15732 1,491.46 1,416.89 1,629.42 15842 3,009.54 2,859.06 3,287.92 15734 1,848.52 1,756.09 2,019.50 15845 1,078.15 1,024.24 1,177.88 # 15734 1,512.94 1,437.29 1,652.88 15851 134.72 127.98 147.18 15736 1,789.89 1,700.40 1,955.46 # 15851 54.76 52.02 59.82 # 15736 1,379.60 1,310.62 1,507.21 15852 145.33 138.06 158.77 15738 1,846.60 1,754.27 2,017.41 # 15852 56.62 53.79 61.86 # 15738 1,480.67 1,406.64 1,617.64 15860 134.65 127.92 147.11 15740 1,027.25 975.89 1,122.27 # 15860 131.74 125.15 143.92 # 15740 917.53 871.65 1,002.40 15920 674.76 641.02 737.17 15750 1,029.33 977.86 1,124.54 15922 860.38 817.36 939.96 15756 2,752.84 2,615.20 3,007.48 15931 740.10 703.10 808.57 15757 2,796.48 2,656.66 3,055.16 15933 938.60 891.67 1,025.42 15758 2,797.76 2,657.87 3,056.55 15934 1,031.16 979.60 1,126.54 15760 964.30 916.09 1,053.50 15935 1,249.06 1,186.61 1,364.60 # 15760 802.64 762.51 876.89 15936 1,028.48 977.06 1,123.62 15770 723.29 687.13 790.20 15937 1,204.42 1,144.20 1,315.83 15775 421.48 400.41 460.47 15940 774.18 735.47 845.79 # 15775 249.89 237.40 273.01 15941 1,059.57 1,006.59 1,157.58 15776 556.85 529.01 608.36 15944 1,010.38 959.86 1,103.84 # 15776 407.45 387.08 445.14 15945 1,126.49 1,070.17 1,230.70 15780 988.21 938.80 1,079.62 15946 1,797.40 1,707.53 1,963.66 # 15780 796.78 756.94 870.48 15950 649.77 617.28 709.87 15781 610.88 580.34 667.39 15951 933.16 886.50 1,019.48 # 15781 520.42 494.40 568.56 15952 956.76 908.92 1,045.26 15782 761.30 723.24 831.73 15953 1,084.95 1,030.70 1,185.31 # 15782 568.12 539.71 620.67 15956 1,317.06 1,251.21 1,438.89 15783 584.19 554.98 638.23 15958 1,332.10 1,265.50 1,455.33 # 15783 426.61 405.28 466.07 16000 88.55 84.12 96.74 15786 281.93 267.83 308.00 # 16000 53.53 50.85 58.48 # 15786 162.87 154.73 177.94 16020 109.95 104.45 120.12 15787 78.07 74.17 85.30 # 16020 68.52 65.09 74.85 # 15787 23.80 22.61 26.00 16025 183.58 174.40 200.56 15788 481.08 457.03 525.58 # 16025 136.31 129.49 148.91 # 15788 268.64 255.21 293.49 16030 218.09 207.19 238.27 15789 679.42 645.45 742.27 # 16030 156.23 148.42 170.68 # 15789 486.82 462.48 531.85 16035 256.24 243.43 279.94 15792 494.27 469.56 539.99 16036 101.16 96.10 110.52 # 15792 339.61 322.63 371.02 17000 81.92 77.82 89.49 15793 525.12 498.86 573.69 # 17000 56.83 53.99 62.09 # 15793 413.65 392.97 451.92 17003 12.81 12.17 14.00 15819 826.98 785.63 903.47 # 17003 10.47 9.95 11.44 15820 628.07 596.67 686.17 17004 251.84 239.25 275.14 # 15820 545.78 518.49 596.26 # 17004 209.82 199.33 229.23 15821 674.79 641.05 737.21 17106 465.04 441.79 508.06 # 15821 579.07 550.12 632.64 # 17106 390.92 371.37 427.08 15822 532.12 505.51 581.34 17107 811.34 770.77 886.39 # 15822 453.33 430.66 495.26 # 17107 709.21 673.75 774.81 15823 759.70 721.72 829.98 17108 1,095.49 1,040.72 1,196.83 # 15823 676.82 642.98 739.43 # 17108 1,001.53 951.45 1,094.17 15831 1,025.57 974.29 1,120.43 17110 122.37 116.25 133.69 15832 1,000.77 950.73 1,093.34 # 17110 68.68 65.25 75.04 15833 950.30 902.79 1,038.21 17111 136.37 129.55 148.98 15834 931.32 884.75 1,017.46 # 17111 86.18 81.87 94.15 15835 955.99 908.19 1,044.42 17250 93.10 88.45 101.72 15836 810.47 769.95 885.44 # 17250 41.74 39.65 45.60 15837 872.76 829.12 953.49 17260 112.97 107.32 123.42 # 15837 803.89 763.70 878.26 # 17260 77.37 73.50 84.53 15838 660.34 627.32 721.42 17261 143.13 135.97 156.37 15839 929.00 882.55 1,014.93 # 17261 97.61 92.73 106.64 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 09 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 176.53 167.70 192.86 19110 528.21 501.80 577.07 # 17262 125.75 119.46 137.38 # 19110 356.62 338.79 389.61 17263 195.30 185.54 213.37 19112 516.05 490.25 563.79 # 17263 138.68 131.75 151.51 # 19112 318.20 302.29 347.63 17264 211.60 201.02 231.17 19120 510.05 484.55 557.23 # 17264 146.82 139.48 160.40 # 19120 423.67 402.49 462.86 17266 244.59 232.36 267.21 19125 546.18 518.87 596.70 # 17266 169.30 160.84 184.97 # 19125 458.63 435.70 501.06 17270 154.54 146.81 168.83 19126 187.32 177.95 204.64 # 17270 106.10 100.80 115.92 19140 644.22 612.01 703.81 17271 166.41 158.09 181.80 # 19140 424.78 403.54 464.07 # 17271 119.72 113.73 130.79 19160 463.70 440.52 506.60 17272 190.97 181.42 208.63 19162 966.06 917.76 1,055.42 # 17272 139.03 132.08 151.89 19180 681.34 647.27 744.36 17273 214.95 204.20 234.83 19182 618.46 587.54 675.67 # 17273 156.59 148.76 171.07 19200 1,144.61 1,087.38 1,250.49 17274 258.58 245.65 282.50 19220 1,173.25 1,114.59 1,281.78 # 17274 192.63 183.00 210.45 19240 1,184.13 1,124.92 1,293.66 17276 307.17 291.81 335.58 19260 1,334.13 1,267.42 1,457.53 # 17276 233.05 221.40 254.61 19271 1,884.97 1,790.72 2,059.33 17280 143.13 135.97 156.37 19272 2,059.40 1,956.43 2,249.89 # 17280 96.44 91.62 105.36 19290 220.64 209.61 241.05 17281 183.67 174.49 200.66 # 19290 78.24 74.33 85.48 # 17281 135.81 129.02 148.37 19291 97.39 92.52 106.40 17282 211.62 201.04 231.20 # 19291 39.03 37.08 42.64 # 17282 157.93 150.03 172.53 19295 157.81 149.92 172.41 17283 259.69 246.71 283.72 19296 7,496.27 7,121.46 8,189.68 # 17283 197.83 187.94 216.13 # 19296 246.52 234.19 269.32 17284 305.72 290.43 333.99 19297 111.84 106.25 122.19 # 17284 237.44 225.57 259.41 19298 2,723.65 2,587.47 2,975.59 17286 401.86 381.77 439.04 # 19298 397.34 377.47 434.09 # 17286 330.07 313.57 360.61 19316 914.94 869.19 999.57 17304 800.45 760.43 874.49 19318 1,360.77 1,292.73 1,486.64 # 17304 526.74 500.40 575.46 19324 544.89 517.65 595.30 17305 347.10 329.75 379.21 19325 758.54 720.61 828.70 # 17305 197.70 187.82 215.99 19328 547.11 519.75 597.71 17306 348.27 330.86 380.49 19330 693.04 658.39 757.15 # 17306 198.28 188.37 216.63 19340 465.75 442.46 508.83 17307 327.84 311.45 358.17 19342 1,023.09 971.94 1,117.73 # 17307 198.86 188.92 217.26 19350 1,208.03 1,147.63 1,319.77 17310 134.22 127.51 146.64 # 19350 817.59 776.71 893.22 # 17310 66.52 63.19 72.67 19355 931.31 884.74 1,017.45 17340 53.93 51.23 58.91 # 19355 606.23 575.92 662.31 # 17340 53.35 50.68 58.28 19357 1,725.13 1,638.87 1,884.70 17360 144.11 136.90 157.44 19361 1,583.87 1,504.68 1,730.38 # 17360 110.84 105.30 121.10 19364 3,200.61 3,040.58 3,496.67 19000 152.45 144.83 166.55 19366 1,623.91 1,542.71 1,774.12 # 19000 54.40 51.68 59.43 19367 2,123.62 2,017.44 2,320.06 19001 32.74 31.10 35.77 19368 2,562.04 2,433.94 2,799.03 # 19001 26.32 25.00 28.75 19369 2,402.05 2,281.95 2,624.24 19020 527.01 500.66 575.76 19370 763.38 725.21 833.99 # 19020 312.82 297.18 341.76 19371 877.98 834.08 959.19 19030 232.36 220.74 253.85 19380 858.24 815.33 937.63 # 19030 94.04 89.34 102.74 19396 158.96 151.01 173.66 19100 177.76 168.87 194.20 # 19396 153.71 146.02 167.92 # 19100 80.30 76.29 87.73 20000 250.31 237.79 273.46 19101 402.66 382.53 439.91 # 20000 194.28 184.57 212.26 # 19101 251.50 238.93 274.77 20005 354.75 337.01 387.56 19102 309.40 293.93 338.02 # 20005 282.38 268.26 308.50 # 19102 123.81 117.62 135.26 20100 701.47 666.40 766.36 19103 830.65 789.12 907.49 20101 488.90 464.46 534.13 # 19103 230.10 218.60 251.39 # 20101 236.78 224.94 258.68 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 09 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 609.06 578.61 665.40 20692 507.32 481.95 554.24 # 20102 283.99 269.79 310.26 20693 581.19 552.13 634.95 20103 736.20 699.39 804.30 20694 604.45 574.23 660.36 # 20103 432.72 411.08 472.74 # 20694 422.95 401.80 462.07 20150 1,018.98 968.03 1,113.23 20802 2,999.86 2,849.87 3,277.35 20200 242.61 230.48 265.05 20805 4,168.31 3,959.89 4,553.87 # 20200 108.96 103.51 119.04 20808 5,154.69 4,896.96 5,631.50 20205 331.62 315.04 362.30 20816 3,583.21 3,404.05 3,914.66 # 20205 173.46 164.79 189.51 20822 3,168.91 3,010.46 3,462.03 20206 422.76 401.62 461.86 20824 3,512.31 3,336.69 3,837.19 # 20206 79.00 75.05 86.31 20827 3,300.97 3,135.92 3,606.31 20220 320.67 304.64 350.34 20838 3,026.58 2,875.25 3,306.54 # 20220 100.06 95.06 109.32 20900 743.29 706.13 812.05 20225 1,512.83 1,437.19 1,652.77 # 20900 582.21 553.10 636.07 # 20225 147.74 140.35 161.40 20902 741.92 704.82 810.54 20240 292.05 277.45 319.07 20910 538.49 511.57 588.31 20245 733.50 696.83 801.35 20912 615.09 584.34 671.99 20250 434.23 412.52 474.40 20920 479.51 455.53 523.86 20251 497.48 472.61 543.50 20922 728.12 691.71 795.47 20500 185.71 176.42 202.88 # 20922 571.71 543.12 624.59 # 20500 142.52 135.39 155.70 20924 633.69 602.01 692.31 20501 202.53 192.40 221.26 20926 524.28 498.07 572.78 # 20501 46.70 44.37 51.03 20931 138.41 131.49 151.21 20520 251.15 238.59 274.38 20937 211.50 200.93 231.07 # 20520 184.04 174.84 201.07 20938 229.64 218.16 250.88 20525 690.09 655.59 753.93 20950 456.66 433.83 498.90 # 20525 308.41 292.99 336.94 # 20950 114.07 108.37 124.63 20526 98.17 93.26 107.25 20955 3,139.30 2,982.34 3,429.69 # 20526 71.90 68.31 78.56 20956 3,217.72 3,056.83 3,515.35 20550 74.28 70.57 81.16 20957 2,935.61 2,788.83 3,207.15 # 20550 46.27 43.96 50.55 20962 3,311.66 3,146.08 3,617.99 20551 72.30 68.69 78.99 20969 3,468.23 3,294.82 3,789.04 # 20551 51.87 49.28 56.67 20970 3,401.24 3,231.18 3,715.86 20552 70.25 66.74 76.75 20972 3,087.89 2,933.50 3,373.53 # 20552 39.91 37.91 43.60 20973 3,474.54 3,300.81 3,795.93 20553 79.55 75.57 86.91 20974 68.23 64.82 74.54 # 20553 44.54 42.31 48.66 # 20974 59.48 56.51 64.99 20600 66.85 63.51 73.04 20975 218.19 207.28 238.37 # 20600 49.35 46.88 53.91 20979 74.20 70.49 81.06 20605 74.10 70.40 80.96 # 20979 47.35 44.98 51.73 # 20605 50.75 48.21 55.44 20982 6,725.84 6,389.55 7,347.98 20610 90.39 85.87 98.75 # 20982 488.10 463.70 533.26 # 20610 59.45 56.48 64.95 21010 855.72 812.93 934.87 20612 72.46 68.84 79.17 21015 525.71 499.42 574.33 # 20612 52.03 49.43 56.84 21025 1,158.97 1,101.02 1,266.17 20615 303.59 288.41 331.67 # 21025 989.72 940.23 1,081.26 # 20615 206.13 195.82 225.19 21026 672.28 638.67 734.47 20650 236.94 225.09 258.85 # 21026 582.40 553.28 636.27 # 20650 189.08 179.63 206.57 21029 886.15 841.84 968.12 20660 295.11 280.35 322.40 # 21029 747.83 710.44 817.01 # 20660 210.49 199.97 229.97 21030 567.24 538.88 619.71 20661 513.53 487.85 561.03 # 21030 490.79 466.25 536.19 20662 584.87 555.63 638.97 21031 446.28 423.97 487.57 20663 526.44 500.12 575.14 # 21031 355.82 338.03 388.73 20664 782.26 743.15 854.62 21032 456.56 433.73 498.79 20665 184.18 174.97 201.22 # 21032 349.17 331.71 381.47 # 20665 136.90 130.06 149.57 21034 1,634.03 1,552.33 1,785.18 20670 753.07 715.42 822.73 # 21034 1,443.19 1,371.03 1,576.68 # 20670 200.97 190.92 219.56 21040 570.75 542.21 623.54 20680 664.07 630.87 725.50 # 21040 472.70 449.07 516.43 # 20680 367.59 349.21 401.59 21044 1,060.19 1,007.18 1,158.26 20690 304.64 289.41 332.82 21045 1,420.74 1,349.70 1,552.16 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 9 FSY06 LOCALITY FEE SCHEDULE FOR AREA 09 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 1,271.35 1,207.78 1,388.95 21175 2,511.08 2,385.53 2,743.36 21047 1,603.57 1,523.39 1,751.90 21179 1,803.06 1,712.91 1,969.85 21048 1,303.81 1,238.62 1,424.41 21180 2,011.83 1,911.24 2,197.93 21049 1,536.15 1,459.34 1,678.24 21181 872.68 829.05 953.41 21050 1,027.55 976.17 1,122.60 21182 2,502.02 2,376.92 2,733.46 21060 954.30 906.59 1,042.58 21183 2,768.68 2,630.25 3,024.79 21070 780.75 741.71 852.97 21184 2,981.46 2,832.39 3,257.25 21076 1,318.63 1,252.70 1,440.61 21188 2,063.49 1,960.32 2,254.37 # 21076 1,180.90 1,121.86 1,290.14 21193 1,494.32 1,419.60 1,632.54 21077 3,321.04 3,154.99 3,628.24 21194 1,664.11 1,580.90 1,818.04 # 21077 3,009.38 2,858.91 3,287.75 21195 1,611.15 1,530.59 1,760.18 21079 2,246.06 2,133.76 2,453.82 21196 1,740.89 1,653.85 1,901.93 # 21079 1,991.60 1,892.02 2,175.82 21198 1,356.84 1,289.00 1,482.35 21080 2,547.52 2,420.14 2,783.16 21199 1,221.11 1,160.05 1,334.06 # 21080 2,247.54 2,135.16 2,455.43 21206 1,347.78 1,280.39 1,472.45 21081 2,316.06 2,200.26 2,530.30 21208 1,750.73 1,663.19 1,912.67 # 21081 2,034.75 1,933.01 2,222.96 # 21208 1,004.86 954.62 1,097.81 21082 2,058.75 1,955.81 2,249.18 21209 928.06 881.66 1,013.91 # 21082 1,847.48 1,755.11 2,018.38 # 21209 768.15 729.74 839.20 21083 1,956.36 1,858.54 2,137.32 21210 1,904.36 1,809.14 2,080.51 # 21083 1,701.32 1,616.25 1,858.69 # 21210 996.24 946.43 1,088.39 21084 2,285.70 2,171.42 2,497.13 21215 2,927.44 2,781.07 3,198.23 # 21084 2,008.48 1,908.06 2,194.27 # 21215 1,024.25 973.04 1,119.00 21085 883.04 838.89 964.72 21230 941.14 894.08 1,028.19 # 21085 794.91 755.16 868.43 21235 865.40 822.13 945.45 21086 2,495.67 2,370.89 2,726.52 # 21235 664.63 631.40 726.11 # 21086 2,243.55 2,131.37 2,451.08 21240 1,332.12 1,265.51 1,455.34 21087 2,462.65 2,339.52 2,690.45 21242 1,244.93 1,182.68 1,360.08 # 21087 2,223.36 2,112.19 2,429.02 21243 1,946.62 1,849.29 2,126.68 21088 2,781.77 2,642.68 3,039.08 21244 1,222.49 1,161.37 1,335.58 21100 855.24 812.48 934.35 21245 1,355.94 1,288.14 1,481.36 # 21100 457.79 434.90 500.14 # 21245 1,089.81 1,035.32 1,190.62 21110 789.60 750.12 862.64 21246 1,071.23 1,017.67 1,170.32 # 21110 718.98 683.03 785.48 21247 2,007.85 1,907.46 2,193.58 21116 287.91 273.51 314.54 21248 1,216.10 1,155.30 1,328.60 # 21116 53.88 51.19 58.87 # 21248 1,056.19 1,003.38 1,153.89 21120 834.89 793.15 912.12 21249 1,753.34 1,665.67 1,915.52 # 21120 653.97 621.27 714.46 # 21249 1,517.56 1,441.68 1,657.93 21121 903.37 858.20 986.93 21255 1,683.79 1,599.60 1,839.54 # 21121 791.32 751.75 864.51 21256 1,389.59 1,320.11 1,518.13 21122 878.02 834.12 959.24 21260 1,446.45 1,374.13 1,580.25 21123 1,121.33 1,065.26 1,225.05 21261 2,786.88 2,647.54 3,044.67 21125 3,685.23 3,500.97 4,026.12 21263 2,341.24 2,224.18 2,557.81 # 21125 939.88 892.89 1,026.82 21267 1,970.72 1,872.18 2,153.01 21127 2,995.27 2,845.51 3,272.34 21268 2,269.64 2,156.16 2,479.58 # 21127 1,043.64 991.46 1,140.18 21270 1,117.20 1,061.34 1,220.54 21137 885.15 840.89 967.02 # 21270 859.82 816.83 939.35 21138 1,097.26 1,042.40 1,198.76 21275 967.43 919.06 1,056.92 21139 1,273.06 1,209.41 1,390.82 21280 603.36 573.19 659.17 21141 1,594.42 1,514.70 1,741.91 21282 410.83 390.29 448.83 21142 1,575.80 1,497.01 1,721.56 21295 214.70 203.97 234.57 21143 1,677.88 1,593.99 1,833.09 21296 468.95 445.50 512.33 21145 1,695.74 1,610.95 1,852.59 21300 170.84 162.30 186.65 21146 1,816.53 1,725.70 1,984.56 # 21300 47.70 45.32 52.12 21147 1,815.08 1,724.33 1,982.98 21310 158.60 150.67 173.27 21150 2,073.72 1,970.03 2,265.53 # 21310 33.70 32.02 36.82 21151 2,556.02 2,428.22 2,792.45 21315 312.64 297.01 341.56 21154 2,660.77 2,527.73 2,906.89 # 21315 175.48 166.71 191.72 21155 2,962.23 2,814.12 3,236.24 21320 308.83 293.39 337.40 21159 3,626.02 3,444.72 3,961.43 # 21320 174.60 165.87 190.75 21160 3,605.58 3,425.30 3,939.10 21325 665.67 632.39 727.25 21172 2,025.43 1,924.16 2,212.78 21330 801.08 761.03 875.18 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 09 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 933.10 886.45 1,019.42 # 21480 37.50 35.63 40.97 21336 809.56 769.08 884.44 21485 655.93 623.13 716.60 21337 475.57 451.79 519.56 # 21485 623.25 592.09 680.90 # 21337 326.16 309.85 356.33 21490 1,098.09 1,043.19 1,199.67 21338 1,104.07 1,048.87 1,206.20 21495 736.23 699.42 804.33 21339 1,167.17 1,108.81 1,275.13 21497 663.79 630.60 725.19 21340 958.95 911.00 1,047.65 # 21497 616.51 585.68 673.53 21343 1,469.53 1,396.05 1,605.46 21501 541.66 514.58 591.77 21344 1,829.65 1,738.17 1,998.90 # 21501 389.33 369.86 425.34 21345 931.59 885.01 1,017.76 21502 643.77 611.58 703.32 # 21345 775.18 736.42 846.88 21510 584.99 555.74 639.10 21346 1,176.70 1,117.87 1,285.55 21550 297.73 282.84 325.27 21347 1,501.46 1,426.39 1,640.35 # 21550 188.59 179.16 206.03 21348 1,390.70 1,321.17 1,519.35 21555 513.69 488.01 561.21 21355 526.87 500.53 575.61 # 21555 377.70 358.82 412.64 # 21355 365.79 347.50 399.63 21556 482.95 458.80 527.62 21356 597.15 567.29 652.38 21557 702.18 667.07 767.13 # 21356 446.58 424.25 487.89 21600 640.62 608.59 699.88 21360 628.92 597.47 687.09 21610 1,187.93 1,128.53 1,297.81 21365 1,285.27 1,221.01 1,404.16 21615 828.90 787.46 905.58 21366 1,448.09 1,375.69 1,582.04 21616 1,005.14 954.88 1,098.11 21385 882.15 838.04 963.75 21620 650.29 617.78 710.45 21386 811.53 770.95 886.59 21627 671.29 637.73 733.39 21387 946.52 899.19 1,034.07 21630 1,463.91 1,390.71 1,599.32 21390 891.94 847.34 974.44 21632 1,454.10 1,381.40 1,588.61 21395 1,080.74 1,026.70 1,180.71 21685 1,140.62 1,083.59 1,246.13 21400 213.80 203.11 233.58 21700 520.68 494.65 568.85 # 21400 170.61 162.08 186.39 21705 753.16 715.50 822.83 21401 609.98 579.48 666.40 21720 397.70 377.82 434.49 # 21401 346.77 329.43 378.84 21725 632.83 601.19 691.37 21406 660.02 627.02 721.07 21740 1,228.82 1,167.38 1,342.49 21407 776.02 737.22 847.80 21750 836.28 794.47 913.64 21408 1,060.26 1,007.25 1,158.34 21800 119.67 113.69 130.74 21421 773.53 734.85 845.08 21805 308.91 293.46 337.48 # 21421 713.42 677.75 779.41 21810 593.30 563.64 648.19 21422 836.46 794.64 913.84 21820 163.00 154.85 178.08 21423 1,000.78 950.74 1,093.35 # 21820 159.50 151.53 174.26 21431 862.32 819.20 942.08 21825 703.23 668.07 768.28 21432 843.08 800.93 921.07 21920 279.76 265.77 305.64 21433 2,062.49 1,959.37 2,253.28 # 21920 173.55 164.87 189.60 21435 1,495.62 1,420.84 1,633.97 21925 499.92 474.92 546.16 21436 2,286.21 2,171.90 2,497.69 # 21925 387.28 367.92 423.11 21440 535.05 508.30 584.55 21930 554.33 526.61 605.60 # 21440 480.19 456.18 524.61 # 21930 418.93 397.98 457.68 21445 809.04 768.59 883.88 21935 1,355.63 1,287.85 1,481.03 # 21445 727.91 691.51 795.24 22010 1,013.13 962.47 1,106.84 21450 561.33 533.26 613.25 22015 1,004.66 954.43 1,097.59 # 21450 531.57 504.99 580.74 22100 888.33 843.91 970.50 21451 761.33 723.26 831.75 22101 899.19 854.23 982.36 # 21451 705.30 670.04 770.55 22102 919.51 873.53 1,004.56 21452 849.66 807.18 928.26 22103 176.73 167.89 193.07 # 21452 357.08 339.23 390.11 22110 1,121.59 1,065.51 1,225.34 21453 872.47 828.85 953.18 22112 1,125.39 1,069.12 1,229.49 # 21453 871.88 828.29 952.53 22114 1,126.74 1,070.40 1,230.96 21454 650.01 617.51 710.14 22116 174.95 166.20 191.13 21461 1,785.68 1,696.40 1,950.86 22210 2,002.22 1,902.11 2,187.43 # 21461 1,095.26 1,040.50 1,196.58 22212 1,661.90 1,578.81 1,815.63 21462 2,046.52 1,944.19 2,235.82 22214 1,694.87 1,610.13 1,851.65 # 21462 1,174.59 1,115.86 1,283.24 22216 460.27 437.26 502.85 21465 1,096.62 1,041.79 1,198.06 22220 1,788.91 1,699.46 1,954.38 21470 1,376.91 1,308.06 1,504.27 22222 1,627.64 1,546.26 1,778.20 21480 130.29 123.78 142.35 22224 1,809.94 1,719.44 1,977.36 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 09 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 457.94 435.04 500.30 # 23000 452.65 430.02 494.52 22305 228.47 217.05 249.61 23020 843.74 801.55 921.78 # 22305 205.70 195.42 224.73 23030 585.88 556.59 640.08 22310 282.56 268.43 308.69 # 23030 323.25 307.09 353.15 # 22310 256.30 243.49 280.01 23031 582.88 553.74 636.80 22315 971.45 922.88 1,061.31 # 23031 282.32 268.20 308.43 # 22315 833.72 792.03 910.83 23035 870.44 826.92 950.96 22318 1,785.27 1,696.01 1,950.41 23040 873.70 830.02 954.52 22319 1,982.26 1,883.15 2,165.62 23044 696.64 661.81 761.08 22325 1,545.21 1,467.95 1,688.14 23065 243.07 230.92 265.56 22326 1,647.51 1,565.13 1,799.90 # 23065 192.29 182.68 210.08 22327 1,601.59 1,521.51 1,749.74 23066 633.55 601.87 692.15 22328 342.80 325.66 374.51 # 23066 417.61 396.73 456.24 22505 139.85 132.86 152.79 23075 320.06 304.06 349.67 22520 4,013.54 3,812.86 4,384.79 # 23075 210.34 199.82 229.79 # 22520 702.66 667.53 767.66 23076 663.69 630.51 725.09 22521 3,654.38 3,471.66 3,992.41 23077 1,310.52 1,244.99 1,431.74 # 22521 667.99 634.59 729.78 23100 601.80 571.71 657.47 22522 293.30 278.64 320.44 23101 562.82 534.68 614.88 22523 745.16 707.90 814.09 23105 786.58 747.25 859.34 22524 714.89 679.15 781.02 23106 600.70 570.67 656.27 22525 333.01 316.36 363.81 23107 819.95 778.95 895.79 22532 1,949.99 1,852.49 2,130.36 23120 697.75 662.86 762.29 22533 1,815.26 1,724.50 1,983.18 23125 864.45 821.23 944.41 22534 451.88 429.29 493.68 23130 756.51 718.68 826.48 22548 2,111.08 2,005.53 2,306.36 23140 612.91 582.26 669.60 22554 1,587.37 1,508.00 1,734.20 23145 842.16 800.05 920.06 22556 1,922.58 1,826.45 2,100.42 23146 767.98 729.58 839.02 22558 1,763.28 1,675.12 1,926.39 23150 782.88 743.74 855.30 22585 418.58 397.65 457.30 23155 952.50 904.88 1,040.61 22590 1,729.69 1,643.21 1,889.69 23156 822.06 780.96 898.10 22595 1,646.43 1,564.11 1,798.73 23170 659.29 626.33 720.28 22600 1,401.59 1,331.51 1,531.24 23172 673.59 639.91 735.90 22610 1,404.92 1,334.67 1,534.87 23174 916.75 870.91 1,001.55 22612 1,793.84 1,704.15 1,959.77 23180 909.76 864.27 993.91 22614 491.59 467.01 537.06 23182 865.61 822.33 945.68 22630 1,758.21 1,670.30 1,920.85 23184 966.99 918.64 1,056.44 22632 396.62 376.79 433.31 23190 684.78 650.54 748.12 22800 1,581.26 1,502.20 1,727.53 23195 893.44 848.77 976.09 22802 2,552.95 2,425.30 2,789.10 23200 1,049.83 997.34 1,146.94 22804 2,974.67 2,825.94 3,249.83 23210 1,084.47 1,030.25 1,184.79 22808 2,143.40 2,036.23 2,341.66 23220 1,286.76 1,222.42 1,405.78 22810 2,432.19 2,310.58 2,657.17 23221 1,482.44 1,408.32 1,619.57 22812 2,635.16 2,503.40 2,878.91 23222 1,994.17 1,894.46 2,178.63 22818 2,556.20 2,428.39 2,792.65 23330 296.78 281.94 324.23 22819 2,842.33 2,700.21 3,105.24 # 23330 191.73 182.14 209.46 22830 962.64 914.51 1,051.69 23331 729.00 692.55 796.43 22840 957.43 909.56 1,045.99 23332 1,068.02 1,014.62 1,166.81 22842 958.74 910.80 1,047.42 23350 244.93 232.68 267.58 22843 1,003.21 953.05 1,096.01 # 23350 61.68 58.60 67.39 22844 1,259.14 1,196.18 1,375.61 23395 1,510.28 1,434.77 1,649.99 22845 910.72 865.18 994.96 23397 1,389.02 1,319.57 1,517.51 22846 947.06 899.71 1,034.67 23400 1,196.78 1,136.94 1,307.48 22847 1,044.88 992.64 1,141.54 23405 781.34 742.27 853.61 22848 458.35 435.43 500.74 23406 972.75 924.11 1,062.73 22849 1,533.86 1,457.17 1,675.75 23410 1,109.96 1,054.46 1,212.63 22850 846.13 803.82 924.39 23412 1,177.29 1,118.43 1,286.19 22851 505.77 480.48 552.55 23415 915.87 870.08 1,000.59 22852 810.10 769.60 885.04 23420 1,232.32 1,170.70 1,346.31 22855 1,266.03 1,202.73 1,383.14 23430 922.70 876.57 1,008.06 22900 443.55 421.37 484.58 23440 954.21 906.50 1,042.48 23000 693.10 658.45 757.22 23450 1,178.29 1,119.38 1,287.29 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 09 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 1,257.01 1,194.16 1,373.28 23931 425.96 404.66 465.36 23460 1,356.23 1,288.42 1,481.68 # 23931 207.11 196.75 226.26 23462 1,315.57 1,249.79 1,437.26 23935 619.66 588.68 676.98 23465 1,367.13 1,298.77 1,493.59 24000 577.57 548.69 630.99 23466 1,304.45 1,239.23 1,425.11 24006 869.51 826.03 949.93 23470 1,488.14 1,413.73 1,625.79 24065 277.19 263.33 302.83 23472 1,791.89 1,702.30 1,957.65 # 24065 191.39 181.82 209.09 23480 1,016.03 965.23 1,110.01 24066 754.66 716.93 824.47 23485 1,182.67 1,123.54 1,292.07 # 24066 473.35 449.68 517.13 23490 1,028.52 977.09 1,123.65 24075 603.43 573.26 659.25 23491 1,265.52 1,202.24 1,382.58 # 24075 372.31 353.69 406.74 23500 260.32 247.30 284.40 24076 564.13 535.92 616.31 # 23500 239.89 227.90 262.09 24077 974.11 925.40 1,064.21 23505 422.96 401.81 462.08 24100 485.77 461.48 530.70 # 23505 389.70 370.22 425.75 24101 622.01 590.91 679.55 23515 716.46 680.64 782.74 24102 761.14 723.08 831.54 23520 263.35 250.18 287.71 24105 418.51 397.58 457.22 # 23520 256.93 244.08 280.69 24110 722.06 685.96 788.85 23525 423.42 402.25 462.59 24115 855.02 812.27 934.11 # 23525 388.40 368.98 424.33 24116 1,061.92 1,008.82 1,160.14 23530 674.34 640.62 736.71 24120 644.38 612.16 703.98 23532 767.88 729.49 838.91 24125 708.36 672.94 773.88 23540 265.66 252.38 290.24 24126 778.08 739.18 850.06 # 23540 236.48 224.66 258.36 24130 632.42 600.80 690.92 23545 386.52 367.19 422.27 24134 954.73 906.99 1,043.04 # 23545 338.08 321.18 369.36 24136 781.65 742.57 853.96 23550 698.29 663.38 762.89 24138 815.88 775.09 891.35 23552 808.20 767.79 882.96 24140 943.77 896.58 1,031.07 23570 276.02 262.22 301.55 24145 810.87 770.33 885.88 # 23570 269.02 255.57 293.91 24147 841.89 799.80 919.77 23575 465.12 441.86 508.14 24149 1,315.47 1,249.70 1,437.16 # 23575 431.85 410.26 471.80 24150 1,181.71 1,122.62 1,291.01 23585 849.64 807.16 928.23 24151 1,371.41 1,302.84 1,498.27 23600 397.37 377.50 434.13 24152 898.26 853.35 981.35 # 23600 339.01 322.06 370.37 24153 816.00 775.20 891.48 23605 578.79 549.85 632.33 24155 1,015.97 965.17 1,109.95 # 23605 517.51 491.63 565.37 24160 754.00 716.30 823.75 23615 937.51 890.63 1,024.22 24164 616.78 585.94 673.83 23616 1,783.79 1,694.60 1,948.79 24200 276.41 262.59 301.98 23620 318.93 302.98 348.43 # 24200 171.94 163.34 187.84 # 23620 282.16 268.05 308.26 24201 777.51 738.63 849.42 23625 465.12 441.86 508.14 # 24201 450.68 428.15 492.37 # 23625 426.60 405.27 466.06 24220 268.04 254.64 292.84 23630 718.43 682.51 784.89 # 24220 81.28 77.22 88.80 23650 366.20 347.89 400.07 24300 502.79 477.65 549.30 # 23650 307.26 291.90 335.69 24301 934.38 887.66 1,020.81 23655 446.90 424.56 488.24 24305 724.46 688.24 791.48 23660 710.05 674.55 775.73 24310 593.83 564.14 648.76 23665 511.54 485.96 558.85 24320 912.83 867.19 997.27 # 23665 475.36 451.59 519.33 24330 891.29 846.73 973.74 23670 754.74 717.00 824.55 24331 984.55 935.32 1,075.62 23675 670.80 637.26 732.85 24332 729.79 693.30 797.30 # 23675 612.44 581.82 669.09 24340 763.08 724.93 833.67 23680 926.61 880.28 1,012.32 24341 818.36 777.44 894.06 23700 240.73 228.69 262.99 24342 975.82 927.03 1,066.08 23800 1,243.44 1,181.27 1,358.46 24343 864.16 820.95 944.09 23802 1,337.59 1,270.71 1,461.32 24344 1,301.88 1,236.79 1,422.31 23900 1,566.10 1,487.80 1,710.97 24345 856.80 813.96 936.05 23920 1,235.83 1,174.04 1,350.15 24346 1,290.69 1,226.16 1,410.08 23921 539.83 512.84 589.77 24350 561.81 533.72 613.78 23930 500.53 475.50 546.83 24351 612.17 581.56 668.79 # 23930 265.91 252.61 290.50 24352 650.52 617.99 710.69 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 13 FSY06 LOCALITY FEE SCHEDULE FOR AREA 09 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 650.14 617.63 710.27 24800 1,008.01 957.61 1,101.25 24356 668.60 635.17 730.45 24802 1,222.86 1,161.72 1,335.98 24360 1,107.01 1,051.66 1,209.41 24900 841.83 799.74 919.70 24361 1,246.19 1,183.88 1,361.46 24920 834.19 792.48 911.35 24362 1,261.63 1,198.55 1,378.33 24925 671.87 638.28 734.02 24363 1,629.03 1,547.58 1,779.72 24930 881.81 837.72 963.38 24365 797.59 757.71 871.37 24931 899.51 854.53 982.71 24366 850.32 807.80 928.97 24935 1,155.80 1,098.01 1,262.71 24400 1,015.32 964.55 1,109.23 25000 553.02 525.37 604.18 24410 1,269.73 1,206.24 1,387.18 25001 398.36 378.44 435.21 24420 1,217.36 1,156.49 1,329.96 25020 823.54 782.36 899.71 24430 1,145.73 1,088.44 1,251.71 25023 1,451.83 1,379.24 1,586.13 24435 1,228.41 1,166.99 1,342.04 25024 857.76 814.87 937.10 24470 843.91 801.71 921.97 25025 1,303.31 1,238.14 1,423.86 24495 871.71 828.12 952.34 25028 711.01 675.46 776.78 24498 1,077.75 1,023.86 1,177.44 25031 647.32 614.95 707.19 24500 426.83 405.49 466.31 25035 1,125.53 1,069.25 1,229.64 # 24500 358.55 340.62 391.71 25040 747.81 710.42 816.98 24505 618.51 587.58 675.72 25065 273.62 259.94 298.93 # 24505 547.89 520.50 598.58 # 25065 196.58 186.75 214.76 24515 1,072.76 1,019.12 1,171.99 25066 596.95 567.10 652.17 24516 1,057.00 1,004.15 1,154.77 25075 510.60 485.07 557.83 24530 460.94 437.89 503.57 25076 776.99 738.14 848.86 # 24530 392.65 373.02 428.97 25077 1,140.02 1,083.02 1,245.47 24535 767.29 728.93 838.27 25085 661.49 628.42 722.68 # 24535 696.09 661.29 760.48 25100 481.90 457.81 526.48 24538 933.67 886.99 1,020.04 25101 554.17 526.46 605.43 24545 964.48 916.26 1,053.70 25105 687.96 653.56 751.59 24546 1,368.04 1,299.64 1,494.59 25107 774.06 735.36 845.66 24560 387.04 367.69 422.84 25110 587.29 557.93 641.62 # 24560 311.75 296.16 340.58 25111 425.74 404.45 465.12 24565 636.02 604.22 694.85 25112 509.11 483.65 556.20 # 24565 572.40 543.78 625.35 25115 1,212.73 1,152.09 1,324.90 24566 826.47 785.15 902.92 25116 1,086.03 1,031.73 1,186.49 24575 970.68 922.15 1,060.47 25118 530.68 504.15 579.77 24576 406.30 385.99 443.89 25119 714.18 678.47 780.24 # 24576 345.02 327.77 376.94 25120 980.19 931.18 1,070.86 24577 664.59 631.36 726.06 25125 1,082.56 1,028.43 1,182.69 # 24577 600.98 570.93 656.57 25126 1,100.16 1,045.15 1,201.92 24579 1,038.60 986.67 1,134.67 25130 609.64 579.16 666.03 24582 917.81 871.92 1,002.71 25135 745.19 707.93 814.12 24586 1,341.03 1,273.98 1,465.08 25136 653.97 621.27 714.46 24587 1,323.98 1,257.78 1,446.45 25145 989.75 940.26 1,081.30 24600 468.87 445.43 512.24 25150 797.00 757.15 870.72 # 24600 389.50 370.03 425.53 25151 1,074.61 1,020.88 1,174.01 24605 556.40 528.58 607.87 25170 1,381.38 1,312.31 1,509.16 24615 880.40 836.38 961.84 25210 661.38 628.31 722.56 24620 676.49 642.67 739.07 25215 863.08 819.93 942.92 24635 1,415.05 1,344.30 1,545.95 25230 591.84 562.25 646.59 24640 159.97 151.97 174.77 25240 637.11 605.25 696.04 # 24640 98.69 93.76 107.82 25246 262.92 249.77 287.24 24650 317.86 301.97 347.27 # 25246 89.59 85.11 97.88 # 24650 257.74 244.85 281.58 25248 725.44 689.17 792.55 24655 544.62 517.39 595.00 25250 650.77 618.23 710.96 # 24655 476.34 452.52 520.40 25251 884.61 840.38 966.44 24665 805.42 765.15 879.92 25259 502.69 477.56 549.19 24666 898.32 853.40 981.41 25260 1,126.10 1,069.80 1,230.27 24670 354.09 336.39 386.85 25263 1,123.77 1,067.58 1,227.72 # 24670 293.39 278.72 320.53 25265 1,276.24 1,212.43 1,394.29 24675 563.19 535.03 615.28 25270 971.44 922.87 1,061.30 # 24675 502.50 477.38 548.99 25272 1,062.73 1,009.59 1,161.03 24685 835.61 793.83 912.90 25274 1,187.07 1,127.72 1,296.88 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 09 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 821.99 780.89 898.02 # 25560 260.48 247.46 284.58 25280 1,060.09 1,007.09 1,158.15 25565 644.14 611.93 703.72 25290 1,112.66 1,057.03 1,215.58 # 25565 569.44 540.97 622.12 25295 1,002.75 952.61 1,095.50 25574 736.37 699.55 804.48 25300 883.94 839.74 965.70 25575 1,026.28 974.97 1,121.22 25301 845.45 803.18 923.66 25600 356.84 339.00 389.85 25310 1,124.17 1,067.96 1,228.15 # 25600 291.48 276.91 318.45 25312 1,240.55 1,178.52 1,355.30 25605 684.07 649.87 747.35 25315 1,296.73 1,231.89 1,416.67 # 25605 625.12 593.86 682.94 25316 1,494.62 1,419.89 1,632.87 25611 873.84 830.15 954.67 25320 1,144.56 1,087.33 1,250.43 25620 807.89 767.50 882.63 25332 1,046.30 993.99 1,143.09 25622 366.30 347.99 400.19 25335 1,249.93 1,187.43 1,365.54 # 25622 298.01 283.11 325.58 25337 1,101.84 1,046.75 1,203.76 25624 571.76 543.17 624.65 25350 1,211.02 1,150.47 1,323.04 # 25624 499.39 474.42 545.58 25355 1,311.19 1,245.63 1,432.47 25628 834.50 792.78 911.70 25360 1,189.67 1,130.19 1,299.72 25630 373.04 354.39 407.55 25365 1,473.03 1,399.38 1,609.29 # 25630 300.67 285.64 328.49 25370 1,540.50 1,463.48 1,683.00 25635 544.55 517.32 594.92 25375 1,547.34 1,469.97 1,690.47 # 25635 424.90 403.66 464.21 25390 1,317.05 1,251.20 1,438.88 25645 712.73 677.09 778.65 25391 1,578.81 1,499.87 1,724.85 25650 387.61 368.23 423.46 25392 1,554.18 1,476.47 1,697.94 # 25650 321.07 305.02 350.77 25393 1,742.63 1,655.50 1,903.83 25651 560.26 532.25 612.09 25394 933.99 887.29 1,020.38 25652 748.92 711.47 818.19 25400 1,377.88 1,308.99 1,505.34 25660 483.70 459.52 528.45 25405 1,653.31 1,570.64 1,806.24 25670 763.07 724.92 833.66 25415 1,563.25 1,485.09 1,707.85 25671 628.83 597.39 687.00 25420 1,798.35 1,708.43 1,964.69 25675 536.37 509.55 585.98 25425 1,840.84 1,748.80 2,011.12 # 25675 477.42 453.55 521.58 25426 1,675.43 1,591.66 1,830.41 25676 787.46 748.09 860.30 25430 837.85 795.96 915.35 25680 540.51 513.48 590.50 25431 962.57 914.44 1,051.61 25685 894.01 849.31 976.71