1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 1 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 135.50 128.73 148.04 D0421 9.26 8.80 10.12 G0182 143.54 136.36 156.81 D0431 9.26 8.80 10.12 G0186 366.43 348.11 400.33 D0475 19.96 18.96 21.80 G0202 154.30 146.59 168.58 D0476 88.24 83.83 96.40 G0202 TC 115.91 110.11 126.63 D0477 64.49 61.27 70.46 G0202 26 38.39 36.47 41.94 D0478 108.59 103.16 118.63 G0204 161.66 153.58 176.62 D0479 141.15 134.09 154.20 G0204 TC 114.12 108.41 124.67 D0481 470.69 447.16 514.23 G0204 26 47.53 45.15 51.92 D0482 103.46 98.29 113.03 G0206 130.79 124.25 142.89 D0483 89.92 85.42 98.23 G0206 TC 92.39 87.77 100.94 D0484 86.55 82.22 94.55 G0206 26 38.39 36.47 41.94 # D0484 76.50 72.68 83.58 G0237 21.56 20.48 23.55 D0485 132.28 125.67 144.52 G0238 22.46 21.34 24.54 D7288 155.91 148.11 170.33 G0239 15.31 14.54 16.72 # D7288 104.83 99.59 114.53 G0245 70.71 67.17 77.25 D7321 344.09 326.89 375.92 # G0245 49.26 46.80 53.82 # D7321 271.18 257.62 296.26 G0246 42.22 40.11 46.13 D7511 282.81 268.67 308.97 # G0246 25.24 23.98 27.58 # D7511 226.93 215.58 247.92 G0247 43.28 41.12 47.29 D7521 162.04 153.94 177.03 # G0247 29.43 27.96 32.15 # D7521 104.85 99.61 114.55 G0248 296.52 281.69 323.94 G0101 41.33 39.26 45.15 G0249 177.67 168.79 194.11 # G0101 25.69 24.41 28.07 G0250 9.98 9.48 10.90 G0102 24.33 23.11 26.58 G0268 52.48 49.86 57.34 # G0102 9.59 9.11 10.48 # G0268 35.05 33.30 38.30 G0104 141.53 134.45 154.62 G0270 21.28 20.22 23.25 # G0104 62.00 58.90 67.74 G0271 8.32 7.90 9.09 G0105 427.45 406.08 466.99 G0275 14.49 13.77 15.84 # G0105 217.90 207.01 238.06 G0278 14.49 13.77 15.84 G0105 53 141.53 134.45 154.62 G0281 12.21 11.60 13.34 # G0105 53 62.00 58.90 67.74 G0283 12.21 11.60 13.34 G0106 157.75 149.86 172.34 G0288 480.48 456.46 524.93 G0106 TC 103.75 98.56 113.34 G0289 100.73 95.69 110.04 G0106 26 53.99 51.29 58.98 G0308 890.65 846.12 973.04 G0108 37.37 35.50 40.83 G0309 741.63 704.55 810.23 G0109 21.73 20.64 23.74 G0310 593.34 563.67 648.22 G0117 49.98 47.48 54.60 G0311 600.00 570.00 655.50 # G0117 26.30 24.99 28.74 G0312 499.73 474.74 545.95 G0118 30.59 29.06 33.42 G0313 399.79 379.80 436.77 # G0118 9.59 9.11 10.48 G0314 528.13 501.72 576.98 G0120 157.75 149.86 172.34 G0315 439.73 417.74 480.40 G0120 TC 103.75 98.56 113.34 G0316 351.65 334.07 384.18 G0120 26 53.99 51.29 58.98 G0317 331.33 314.76 361.97 G0121 427.45 406.08 466.99 G0318 275.92 262.12 301.44 # G0121 217.90 207.01 238.06 G0319 220.51 209.48 240.90 G0121 53 141.53 134.45 154.62 G0320 741.63 704.55 810.23 # G0121 53 62.00 58.90 67.74 G0321 499.73 474.74 545.95 G0124 23.63 22.45 25.82 G0322 439.73 417.74 480.40 G0127 18.08 17.18 19.76 G0323 275.92 262.12 301.44 # G0127 10.03 9.53 10.96 G0324 24.64 23.41 26.92 G0128 4.74 4.50 5.18 G0325 14.60 13.87 15.95 G0130 49.14 46.68 53.68 G0326 16.61 15.78 18.15 G0130 TC 37.15 35.29 40.58 G0327 9.31 8.84 10.17 G0130 26 11.98 11.38 13.09 G0329 8.87 8.43 9.69 G0141 23.63 22.45 25.82 # G0329 3.51 3.33 3.83 G0166 162.97 154.82 178.04 G0332 85.34 81.07 93.23 # G0166 4.35 4.13 4.75 G0341 542.38 515.26 592.55 G0168 105.06 99.81 114.78 # G0341 401.64 381.56 438.79 # G0168 28.21 26.80 30.82 G0342 742.81 705.67 811.52 G0179 64.12 60.91 70.05 G0343 1,223.71 1,162.52 1,336.90 G0180 83.25 79.09 90.95 G0344 105.51 100.23 115.26 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 31146 PAGE 2 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 76.47 72.65 83.55 11006 744.51 707.28 813.37 G0364 13.62 12.94 14.88 11008 302.70 287.57 330.71 # G0364 10.04 9.54 10.97 11010 489.70 465.22 535.00 G0365 195.51 185.73 213.59 # 11010 299.36 284.39 327.05 G0365 TC 181.19 172.13 197.95 11011 578.81 549.87 632.35 G0365 26 14.32 13.60 15.64 # 11011 318.32 302.40 347.76 G0366 30.26 28.75 33.06 11012 842.78 800.64 920.74 G0367 20.67 19.64 22.59 # 11012 472.38 448.76 516.07 G0368 9.59 9.11 10.48 11040 44.41 42.19 48.52 G0372 24.33 23.11 26.58 # 11040 30.55 29.02 33.37 # G0372 9.59 9.11 10.48 11041 64.26 61.05 70.21 G0375 13.65 12.97 14.92 # 11041 49.51 47.03 54.08 G0376 27.02 25.67 29.52 11042 90.64 86.11 99.03 # G0376 26.58 25.25 29.04 # 11042 66.96 63.61 73.15 M0064 29.89 28.40 32.66 11043 253.21 240.55 276.63 # M0064 20.06 19.06 21.92 # 11043 217.92 207.02 238.07 P3001 23.63 22.45 25.82 11044 330.62 314.09 361.20 Q0035 27.58 26.20 30.13 # 11044 299.34 284.37 327.03 Q0035 TC 17.99 17.09 19.65 11055 43.18 41.02 47.17 Q0035 26 9.59 9.11 10.48 # 11055 25.76 24.47 28.14 Q0091 44.91 42.66 49.06 11056 54.33 51.61 59.35 # Q0091 21.23 20.17 23.20 # 11056 36.02 34.22 39.35 Q0092 14.58 13.85 15.93 11057 66.66 63.33 72.83 R0070 174.06 165.36 190.16 # 11057 47.00 44.65 51.35 R0075 174.06 165.36 190.16 11100 88.25 83.84 96.42 0016T 366.43 348.11 400.33 # 11100 48.93 46.48 53.45 0024T 634.63 602.90 693.34 11101 31.28 29.72 34.18 0030T 26.60 25.27 29.06 # 11101 25.03 23.78 27.35 0067T 480.95 456.90 525.44 11200 77.59 73.71 84.77 0067T TC 415.18 394.42 453.58 # 11200 65.08 61.83 71.10 0067T 26 65.77 62.48 71.85 11201 19.01 18.06 20.77 0073T 811.05 770.50 886.08 # 11201 17.22 16.36 18.81 10021 148.81 141.37 162.58 11300 64.95 61.70 70.96 # 10021 76.42 72.60 83.49 # 11300 30.10 28.60 32.89 10022 165.67 157.39 181.00 11301 83.84 79.65 91.60 # 10022 70.50 66.98 77.03 # 11301 51.22 48.66 55.96 10040 92.51 87.88 101.06 11302 100.40 95.38 109.69 # 10040 82.68 78.55 90.33 # 11302 62.87 59.73 68.69 10060 103.03 97.88 112.56 11303 120.88 114.84 132.07 # 10060 90.52 85.99 98.89 # 11303 73.52 69.84 80.32 10061 182.60 173.47 199.49 11305 66.05 62.75 72.16 # 10061 167.85 159.46 183.38 # 11305 40.14 38.13 43.85 10080 187.64 178.26 205.00 11306 89.69 85.21 97.99 # 10080 98.28 93.37 107.38 # 11306 59.31 56.34 64.79 10081 284.51 270.28 310.82 11307 104.03 98.83 113.65 # 10081 169.24 160.78 184.90 # 11307 68.28 64.87 74.60 10120 148.32 140.90 162.04 11308 123.38 117.21 134.79 # 10120 94.25 89.54 102.97 # 11308 84.96 80.71 92.82 10121 271.38 257.81 296.48 11310 79.16 75.20 86.48 # 10121 194.08 184.38 212.04 # 11310 43.87 41.68 47.93 10140 144.50 137.28 157.87 11311 97.27 92.41 106.27 # 10140 122.60 116.47 133.94 # 11311 64.21 61.00 70.15 10160 122.19 116.08 133.49 11312 111.89 106.30 122.25 # 10160 98.95 94.00 108.10 # 11312 73.02 69.37 79.78 10180 231.12 219.56 252.49 11313 146.81 139.47 160.39 # 10180 186.44 177.12 203.69 # 11313 98.10 93.20 107.18 11000 51.26 48.70 56.01 11400 124.17 117.96 135.65 # 11000 35.18 33.42 38.43 # 11400 74.13 70.42 80.98 11001 23.09 21.94 25.23 11401 142.78 135.64 155.99 # 11001 17.73 16.84 19.37 # 11401 96.31 91.49 105.21 11004 595.26 565.50 650.33 11402 162.13 154.02 177.12 11005 812.07 771.47 887.19 # 11402 110.75 105.21 120.99 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 31146 PAGE 3 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 181.76 172.67 198.57 11624 294.38 279.66 321.61 # 11403 133.51 126.83 145.85 # 11624 206.36 196.04 225.45 11404 207.26 196.90 226.44 11626 387.14 367.78 422.95 # 11404 148.73 141.29 162.48 # 11626 287.06 272.71 313.62 11406 253.72 241.03 277.18 11640 174.55 165.82 190.69 # 11406 190.27 180.76 207.87 # 11640 105.29 100.03 115.03 11420 119.80 113.81 130.88 11641 224.05 212.85 244.78 # 11420 82.27 78.16 89.88 # 11641 157.02 149.17 171.55 11421 151.48 143.91 165.50 11642 258.62 245.69 282.54 # 11421 108.58 103.15 118.62 # 11642 182.66 173.53 199.56 11422 168.99 160.54 184.62 11643 298.34 283.42 325.93 # 11422 127.44 121.07 139.23 # 11643 216.12 205.31 236.11 11423 199.67 189.69 218.14 11644 376.60 357.77 411.44 # 11423 148.73 141.29 162.48 # 11644 276.96 263.11 302.58 11424 227.27 215.91 248.30 11646 506.42 481.10 553.27 # 11424 173.21 164.55 189.23 # 11646 404.10 383.90 441.49 11426 315.22 299.46 344.38 11719 18.36 17.44 20.06 # 11426 253.56 240.88 277.01 # 11719 10.31 9.79 11.26 11440 142.30 135.19 155.47 11720 28.79 27.35 31.45 # 11440 102.08 96.98 111.53 # 11720 18.96 18.01 20.71 11441 165.88 157.59 181.23 11721 42.67 40.54 46.62 # 11441 127.90 121.51 139.74 # 11721 32.39 30.77 35.39 11442 185.46 176.19 202.62 11730 93.99 89.29 102.68 # 11442 141.67 134.59 154.78 # 11730 67.18 63.82 73.39 11443 225.89 214.60 246.79 11732 43.84 41.65 47.90 # 11443 176.74 167.90 193.09 # 11732 34.01 32.31 37.16 11444 286.28 271.97 312.77 11740 40.12 38.11 43.83 # 11444 228.64 217.21 249.79 # 11740 31.18 29.62 34.06 11446 367.62 349.24 401.63 11750 175.62 166.84 191.87 # 11446 310.87 295.33 339.63 # 11750 157.30 149.44 171.86 11450 341.14 324.08 372.69 11752 247.93 235.53 270.86 # 11450 206.65 196.32 225.77 11755 125.13 118.87 136.70 11451 464.23 441.02 507.17 # 11755 89.39 84.92 97.66 # 11451 282.38 268.26 308.50 11760 184.99 175.74 202.10 11462 335.58 318.80 366.62 # 11760 147.46 140.09 161.10 # 11462 197.06 187.21 215.29 11762 251.87 239.28 275.17 11463 474.34 450.62 518.21 # 11762 227.74 216.35 248.80 # 11463 288.92 274.47 315.64 11765 109.12 103.66 119.21 11470 364.43 346.21 398.14 # 11765 63.09 59.94 68.93 # 11470 239.32 227.35 261.45 11770 266.92 253.57 291.61 11471 488.03 463.63 533.17 # 11770 178.01 169.11 194.48 # 11471 311.54 295.96 340.35 11771 496.99 472.14 542.96 11600 171.81 163.22 187.70 # 11771 392.44 372.82 428.74 # 11600 97.20 92.34 106.19 11772 632.64 601.01 691.16 11601 194.59 184.86 212.59 # 11772 523.62 497.44 572.06 # 11601 128.02 121.62 139.86 11900 49.87 47.38 54.49 11602 205.80 195.51 224.84 # 11900 30.21 28.70 33.01 # 11602 135.65 128.87 148.20 11901 61.50 58.43 67.19 11603 227.45 216.08 248.49 # 11901 47.65 45.27 52.06 # 11603 149.26 141.80 163.07 11920 235.26 223.50 257.03 11604 250.16 237.65 273.30 # 11920 118.19 112.28 129.12 # 11604 161.25 153.19 176.17 11921 260.75 247.71 284.87 11606 325.24 308.98 355.33 # 11921 140.11 133.10 153.07 # 11606 221.13 210.07 241.58 11922 72.00 68.40 78.66 11620 165.07 156.82 180.34 # 11922 32.23 30.62 35.21 # 11620 91.35 86.78 99.80 11950 85.35 81.08 93.24 11621 193.04 183.39 210.90 # 11950 51.84 49.25 56.64 # 11621 127.36 120.99 139.14 11951 116.04 110.24 126.78 11622 218.07 207.17 238.25 # 11951 72.25 68.64 78.94 # 11622 147.48 140.11 161.13 11952 153.46 145.79 167.66 11623 256.56 243.73 280.29 # 11952 100.73 95.69 110.04 # 11623 177.92 169.02 194.37 11954 188.59 179.16 206.03 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 31146 PAGE 4 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 119.34 113.37 130.38 # 12045 255.30 242.54 278.92 11960 855.87 813.08 935.04 12046 471.73 448.14 515.36 11970 579.05 550.10 632.62 # 12046 303.73 288.54 331.82 11971 500.39 475.37 546.68 12047 481.29 457.23 525.81 # 11971 261.79 248.70 286.01 # 12047 335.19 318.43 366.19 11976 152.12 144.51 166.19 12051 248.42 236.00 271.40 # 11976 105.65 100.37 115.43 # 12051 166.65 158.32 182.07 11980 109.58 104.10 119.72 12052 257.03 244.18 280.81 # 11980 85.45 81.18 93.36 # 12052 176.60 167.77 192.94 11981 137.00 130.15 149.67 12053 273.25 259.59 298.53 # 11981 91.43 86.86 99.89 # 12053 196.40 186.58 214.57 11982 161.27 153.21 176.19 12054 302.38 287.26 330.35 # 11982 111.22 105.66 121.51 # 12054 215.70 204.92 235.66 11983 237.37 225.50 259.33 12055 385.50 366.23 421.16 # 11983 200.73 190.69 219.29 # 12055 280.06 266.06 305.97 12001 159.37 151.40 174.11 12056 522.88 496.74 571.25 # 12001 104.86 99.62 114.56 # 12056 357.11 339.25 390.14 12002 168.85 160.41 184.47 12057 522.38 496.26 570.70 # 12002 117.47 111.60 128.34 # 12057 415.59 394.81 454.03 12004 197.30 187.44 215.56 13100 310.29 294.78 339.00 # 12004 138.32 131.40 151.11 # 13100 232.10 220.50 253.58 12005 245.48 233.21 268.19 13101 368.32 349.90 402.39 # 12005 172.65 164.02 188.62 # 13101 279.85 265.86 305.74 12006 304.37 289.15 332.52 13102 104.25 99.04 113.90 # 12006 219.93 208.93 240.27 # 13102 77.44 73.57 84.61 12007 343.94 326.74 375.75 13120 321.32 305.25 351.04 # 12007 254.13 241.42 277.63 # 13120 240.90 228.86 263.19 12011 168.70 160.27 184.31 13121 392.50 372.88 428.81 # 12011 107.93 102.53 117.91 # 13121 300.46 285.44 328.26 12013 184.48 175.26 201.55 13122 127.80 121.41 139.62 # 12013 124.16 117.95 135.64 # 13122 88.48 84.06 96.67 12014 217.60 206.72 237.73 13131 349.85 332.36 382.21 # 12014 149.69 142.21 163.54 # 13131 274.79 261.05 300.21 12015 272.75 259.11 297.98 13132 504.95 479.70 551.66 # 12015 188.31 178.89 205.72 # 13132 426.76 405.42 466.23 12016 322.22 306.11 352.03 13133 164.57 156.34 179.79 # 12016 231.07 219.52 252.45 # 13133 136.42 129.60 149.04 12017 281.25 267.19 307.27 13150 375.67 356.89 410.42 12018 334.08 317.38 364.99 # 13150 281.40 267.33 307.43 12020 281.66 267.58 307.72 13151 396.63 376.80 433.32 # 12020 196.76 186.92 214.96 # 13151 322.46 306.34 352.29 12021 160.22 152.21 175.04 13152 527.82 501.43 576.64 # 12021 141.45 134.38 154.54 # 13152 438.46 416.54 479.02 12031 190.87 181.33 208.53 13153 186.17 176.86 203.39 # 12031 131.45 124.88 143.61 # 13153 150.43 142.91 164.35 12032 272.76 259.12 297.99 13160 771.74 733.15 843.12 # 12032 181.17 172.11 197.93 14000 597.35 567.48 652.60 12034 263.79 250.60 288.19 # 14000 490.56 466.03 535.93 # 12034 185.60 176.32 202.77 14001 774.50 735.78 846.15 12035 377.02 358.17 411.90 # 14001 669.50 636.03 731.43 # 12035 240.75 228.71 263.02 14020 659.99 626.99 721.04 12036 421.77 400.68 460.78 # 14020 567.05 538.70 619.51 # 12036 286.84 272.50 313.38 14021 861.24 818.18 940.91 12037 473.16 449.50 516.93 # 14021 784.84 745.60 857.44 # 12037 332.86 316.22 363.65 14040 718.23 682.32 784.67 12041 211.63 201.05 231.21 # 14040 646.29 613.98 706.08 # 12041 148.18 140.77 161.89 14041 941.95 894.85 1,029.08 12042 257.65 244.77 281.49 # 14041 856.16 813.35 935.35 # 12042 176.77 167.93 193.12 14060 743.57 706.39 812.35 12044 273.82 260.13 299.15 # 14060 682.81 648.67 745.97 # 12044 201.43 191.36 220.06 14061 1,019.09 968.14 1,113.36 12045 388.90 369.46 424.88 # 14061 925.26 879.00 1,010.85 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 31146 PAGE 5 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 988.72 939.28 1,080.17 # 15221 75.89 72.10 82.92 # 14300 901.15 856.09 984.50 15240 834.82 793.08 912.04 14350 731.70 695.12 799.39 # 15240 733.85 697.16 801.73 15000 340.46 323.44 371.96 15241 188.42 179.00 205.85 # 15000 268.52 255.09 293.35 # 15241 119.61 113.63 130.67 15001 103.23 98.07 112.78 15260 868.13 824.72 948.43 # 15001 61.23 58.17 66.90 # 15260 794.86 755.12 868.39 15040 288.88 274.44 315.61 15261 213.44 202.77 233.19 # 15040 135.17 128.41 147.67 # 15261 155.35 147.58 169.72 15050 492.84 468.20 538.43 15300 312.69 297.06 341.62 # 15050 411.97 391.37 450.08 # 15300 269.35 255.88 294.26 15100 952.15 904.54 1,040.22 15301 63.91 60.71 69.82 # 15100 738.58 701.65 806.90 # 15301 60.78 57.74 66.40 15101 240.88 228.84 263.17 15320 361.65 343.57 395.11 # 15101 126.05 119.75 137.71 # 15320 312.95 297.30 341.90 15110 885.13 840.87 967.00 15321 95.19 90.43 103.99 # 15110 720.71 684.67 787.37 # 15321 90.72 86.18 99.11 15111 137.04 130.19 149.72 15330 312.24 296.63 341.12 # 15111 114.70 108.97 125.32 # 15330 268.90 255.46 293.78 15115 827.91 786.51 904.49 15331 63.46 60.29 69.33 # 15115 743.91 706.71 812.72 # 15331 60.78 57.74 66.40 15116 177.30 168.44 193.71 15335 346.31 328.99 378.34 # 15116 156.74 148.90 171.24 # 15335 300.29 285.28 328.07 15120 895.60 850.82 978.44 15336 92.18 87.57 100.71 # 15120 763.79 725.60 834.44 # 15336 86.82 82.48 94.85 15121 315.68 299.90 344.89 15340 335.66 318.88 366.71 # 15121 196.83 186.99 215.04 # 15340 279.81 265.82 305.69 15130 741.96 704.86 810.59 15341 48.43 46.01 52.91 # 15130 584.23 555.02 638.27 # 15341 30.11 28.60 32.89 15131 112.17 106.56 122.54 15360 363.07 344.92 396.66 # 15131 92.95 88.30 101.55 # 15360 300.96 285.91 328.80 15135 886.09 841.79 968.06 15361 74.66 70.93 81.57 # 15135 807.90 767.51 882.64 # 15361 69.30 65.84 75.72 15136 103.84 98.65 113.45 15365 378.39 359.47 413.39 # 15136 94.01 89.31 102.71 # 15365 317.63 301.75 347.01 15150 732.45 695.83 800.20 15366 92.56 87.93 101.12 # 15150 642.19 610.08 701.59 # 15366 87.20 82.84 95.27 15151 144.34 137.12 157.69 15400 348.32 330.90 380.54 # 15151 123.79 117.60 135.24 15401 127.80 121.41 139.62 15152 176.97 168.12 193.34 # 15401 62.57 59.44 68.36 # 15152 154.63 146.90 168.94 15420 404.00 383.80 441.37 15155 730.53 694.00 798.10 # 15420 359.76 341.77 393.04 # 15155 692.11 657.50 756.13 15421 123.34 117.17 134.75 15156 186.99 177.64 204.29 # 15421 92.06 87.46 100.58 # 15156 172.69 164.06 188.67 15430 551.81 524.22 602.85 15157 207.40 197.03 226.58 # 15430 538.86 511.92 588.71 # 15157 188.19 178.78 205.60 15570 902.44 857.32 985.92 15170 381.88 362.79 417.21 # 15570 699.14 664.18 763.81 # 15170 316.20 300.39 345.45 15572 819.96 778.96 895.80 15171 96.13 91.32 105.02 # 15572 683.68 649.50 746.93 # 15171 93.45 88.78 102.10 15574 896.89 852.05 979.86 15175 538.90 511.96 588.75 # 15574 767.32 728.95 838.29 # 15175 475.00 451.25 518.94 15576 799.67 759.69 873.64 15176 153.22 145.56 167.39 # 15576 670.99 637.44 733.06 # 15176 147.86 140.47 161.54 15600 422.49 401.37 461.58 15200 761.42 723.35 831.85 # 15600 219.19 208.23 239.46 # 15200 618.00 587.10 675.17 15610 314.15 298.44 343.21 15201 171.61 163.03 187.48 # 15610 257.40 244.53 281.21 # 15201 84.48 80.26 92.30 15620 472.92 449.27 516.66 15220 741.41 704.34 809.99 # 15620 298.22 283.31 325.81 # 15220 629.26 597.80 687.47 15630 452.43 429.81 494.28 15221 154.98 147.23 169.31 # 15630 322.85 306.71 352.72 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 31146 PAGE 6 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 486.04 461.74 531.00 # 15839 685.85 651.56 749.29 # 15650 354.67 336.94 387.48 15840 999.84 949.85 1,092.33 15732 1,558.24 1,480.33 1,702.38 15841 1,648.18 1,565.77 1,800.64 # 15732 1,297.31 1,232.44 1,417.31 15842 2,642.31 2,510.19 2,886.72 15734 1,576.91 1,498.06 1,722.77 15845 928.64 882.21 1,014.54 # 15734 1,319.99 1,253.99 1,442.09 15851 110.26 104.75 120.46 15736 1,518.93 1,442.98 1,659.43 # 15851 49.05 46.60 53.59 # 15736 1,204.82 1,144.58 1,316.27 15852 118.70 112.77 129.69 15738 1,576.84 1,498.00 1,722.70 # 15852 50.79 48.25 55.49 # 15738 1,296.69 1,231.86 1,416.64 15860 120.67 114.64 131.84 15740 870.27 826.76 950.77 # 15860 118.43 112.51 129.39 # 15740 786.27 746.96 859.00 15920 587.53 558.15 641.87 15750 889.03 844.58 971.27 15922 748.38 710.96 817.60 15756 2,421.87 2,300.78 2,645.90 15931 649.52 617.04 709.60 15757 2,447.59 2,325.21 2,673.99 15933 816.42 775.60 891.94 15758 2,451.22 2,328.66 2,677.96 15934 903.92 858.72 987.53 15760 813.12 772.46 888.33 15935 1,088.23 1,033.82 1,188.89 # 15760 689.35 654.88 753.11 15936 899.33 854.36 982.51 15770 621.55 590.47 679.04 15937 1,051.02 998.47 1,148.24 15775 358.00 340.10 391.12 15940 677.00 643.15 739.62 # 15775 226.63 215.30 247.60 15941 914.90 869.16 999.53 15776 475.68 451.90 519.69 15944 877.36 833.49 958.51 # 15776 361.30 343.24 394.73 15945 977.55 928.67 1,067.97 15780 818.58 777.65 894.30 15946 1,572.12 1,493.51 1,717.54 # 15780 672.02 638.42 734.18 15950 565.30 537.04 617.60 15781 507.79 482.40 554.76 15951 810.96 770.41 885.97 # 15781 438.53 416.60 479.09 15952 835.25 793.49 912.51 15782 618.95 588.00 676.20 15953 944.76 897.52 1,032.15 # 15782 471.05 447.50 514.63 15956 1,148.73 1,091.29 1,254.98 15783 482.49 458.37 527.13 15958 1,160.36 1,102.34 1,267.69 # 15783 361.85 343.76 395.32 16000 75.35 71.58 82.32 15786 232.32 220.70 253.81 # 16000 48.55 46.12 53.04 # 15786 141.17 134.11 154.23 16020 91.06 86.51 99.49 15787 62.69 59.56 68.49 # 16020 59.34 56.37 64.83 # 15787 21.13 20.07 23.08 16025 156.52 148.69 170.99 15788 385.23 365.97 420.87 # 16025 120.32 114.30 131.45 # 15788 222.59 211.46 243.18 16030 185.21 175.95 202.34 15789 559.29 531.33 611.03 # 16030 137.84 130.95 150.59 # 15789 411.84 391.25 449.94 16035 229.27 217.81 250.48 15792 393.81 374.12 430.24 16036 90.89 86.35 99.30 # 15792 275.41 261.64 300.89 17000 67.56 64.18 73.81 15793 432.16 410.55 472.13 # 17000 48.35 45.93 52.82 # 15793 346.82 329.48 378.90 17003 11.04 10.49 12.06 15819 714.10 678.40 780.16 # 17003 9.25 8.79 10.11 15820 523.85 497.66 572.31 17004 215.01 204.26 234.90 # 15820 460.85 437.81 503.48 # 17004 182.84 173.70 199.76 15821 564.44 536.22 616.65 17106 394.28 374.57 430.76 # 15821 491.16 466.60 536.59 # 17106 337.53 320.65 368.75 15822 444.79 422.55 485.93 17107 696.83 661.99 761.29 # 15822 384.47 365.25 420.04 # 17107 618.64 587.71 675.87 15823 640.01 608.01 699.21 17108 943.79 896.60 1,031.09 # 15823 576.56 547.73 629.89 # 17108 871.85 828.26 952.50 15831 897.14 852.28 980.12 17110 99.12 94.16 108.28 15832 871.09 827.54 951.67 # 17110 58.01 55.11 63.38 15833 823.48 782.31 899.66 17111 111.87 106.28 122.22 15834 811.81 771.22 886.90 # 17111 73.44 69.77 80.24 15835 836.77 794.93 914.17 17250 75.68 71.90 82.69 15836 705.10 669.85 770.33 # 17250 36.36 34.54 39.72 15837 744.22 707.01 813.06 17260 93.77 89.08 102.44 # 15837 691.50 656.93 755.47 # 17260 66.52 63.19 72.67 15838 565.40 537.13 617.70 17261 118.93 112.98 129.93 15839 794.87 755.13 868.40 # 17261 84.08 79.88 91.86 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 31146 PAGE 7 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 147.69 140.31 161.36 19110 442.80 420.66 483.76 # 17262 108.82 103.38 118.89 # 19110 311.44 295.87 340.25 17263 163.75 155.56 178.89 19112 427.78 406.39 467.35 # 17263 120.41 114.39 131.55 # 19112 276.31 262.49 301.86 17264 177.47 168.60 193.89 19120 440.10 418.10 480.82 # 17264 127.88 121.49 139.71 # 19120 373.97 355.27 408.56 17266 205.85 195.56 224.89 19125 472.28 448.67 515.97 # 17266 148.21 140.80 161.92 # 19125 405.26 385.00 442.75 17270 128.79 122.35 140.70 19126 169.54 161.06 185.22 # 17270 91.71 87.12 100.19 19140 539.23 512.27 589.11 17271 139.27 132.31 152.16 # 19140 371.23 352.67 405.57 # 17271 103.53 98.35 113.10 19160 408.50 388.08 446.29 17272 160.29 152.28 175.12 19162 860.53 817.50 940.13 # 17272 120.53 114.50 131.68 19180 600.46 570.44 656.01 17273 180.87 171.83 197.60 19182 542.77 515.63 592.97 # 17273 136.19 129.38 148.79 19200 1,013.38 962.71 1,107.12 17274 218.55 207.62 238.76 19220 1,038.64 986.71 1,134.72 # 17274 168.06 159.66 183.61 19240 1,049.61 997.13 1,146.70 17276 260.99 247.94 285.13 19260 1,160.33 1,102.31 1,267.66 # 17276 204.24 194.03 223.13 19271 1,613.28 1,532.62 1,762.51 17280 118.93 112.98 129.93 19272 1,770.74 1,682.20 1,934.53 # 17280 83.18 79.02 90.87 19290 179.24 170.28 195.82 17281 154.32 146.60 168.59 # 19290 70.22 66.71 76.72 # 17281 117.69 111.81 128.58 19291 79.74 75.75 87.11 17282 178.24 169.33 194.73 # 19291 35.05 33.30 38.30 # 17282 137.14 130.28 149.82 19295 120.92 114.87 132.10 17283 219.89 208.90 240.24 19296 5,770.23 5,481.72 6,303.98 # 17283 172.53 163.90 188.49 # 19296 219.93 208.93 240.27 17284 259.64 246.66 283.66 19297 100.40 95.38 109.69 # 17284 207.36 196.99 226.54 19298 2,135.00 2,028.25 2,332.49 17286 343.50 326.33 375.28 # 19298 354.00 336.30 386.75 # 17286 288.54 274.11 315.23 19316 798.38 758.46 872.23 17304 673.22 639.56 735.49 19318 1,190.52 1,130.99 1,300.64 # 17304 463.67 440.49 506.56 19324 470.14 446.63 513.62 17305 288.39 273.97 315.07 19325 658.53 625.60 719.44 # 17305 174.01 165.31 190.11 19328 471.30 447.74 514.90 17306 289.28 274.82 316.04 19330 601.15 571.09 656.75 # 17306 174.45 165.73 190.59 19340 415.51 394.73 453.94 17307 273.65 259.97 298.97 19342 887.05 842.70 969.11 # 17307 174.90 166.16 191.08 19350 1,007.05 956.70 1,100.21 17310 110.24 104.73 120.44 # 19350 708.13 672.72 773.63 # 17310 58.41 55.49 63.81 19355 779.79 740.80 851.92 17340 47.55 45.17 51.95 # 19355 530.92 504.37 580.03 # 17340 47.10 44.75 51.46 19357 1,488.64 1,414.21 1,626.34 17360 121.74 115.65 133.00 19361 1,388.68 1,319.25 1,517.14 # 17360 96.28 91.47 105.19 19364 2,825.27 2,684.01 3,086.61 19000 123.90 117.71 135.37 19366 1,437.97 1,366.07 1,570.98 # 19000 48.83 46.39 53.35 19367 1,862.44 1,769.32 2,034.72 19001 28.66 27.23 31.31 19368 2,264.33 2,151.11 2,473.78 # 19001 23.75 22.56 25.94 19369 2,111.44 2,005.87 2,306.75 19020 435.11 413.35 475.35 19370 658.79 625.85 719.73 # 19020 271.13 257.57 296.21 19371 759.85 721.86 830.14 19030 190.38 180.86 207.99 19380 741.23 704.17 809.80 # 19030 84.48 80.26 92.30 19396 141.25 134.19 154.32 19100 147.37 140.00 161.00 # 19396 137.23 130.37 149.93 # 19100 72.75 69.11 79.48 20000 210.28 199.77 229.74 19101 336.40 319.58 367.52 # 20000 167.39 159.02 182.87 # 19101 220.67 209.64 241.09 20005 302.20 287.09 330.15 19102 253.44 240.77 276.89 # 20005 246.80 234.46 269.63 # 19102 111.35 105.78 121.65 20100 625.77 594.48 683.65 19103 666.94 633.59 728.63 20101 403.26 383.10 440.57 # 19103 207.17 196.81 226.33 # 20101 210.24 199.73 229.69 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 31146 PAGE 8 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 501.14 476.08 547.49 20692 447.84 425.45 489.27 # 20102 252.26 239.65 275.60 20693 499.50 474.53 545.71 20103 611.50 580.93 668.07 20694 501.61 476.53 548.01 # 20103 379.15 360.19 414.22 # 20694 362.66 344.53 396.21 20150 904.80 859.56 988.49 20802 2,646.99 2,514.64 2,891.84 20200 199.20 189.24 217.63 20805 3,619.15 3,438.19 3,953.92 # 20200 96.88 92.04 105.85 20808 4,483.52 4,259.34 4,898.24 20205 275.11 261.35 300.55 20816 3,024.29 2,873.08 3,304.04 # 20205 154.03 146.33 168.28 20822 2,663.24 2,530.08 2,909.59 20206 331.86 315.27 362.56 20824 2,970.98 2,822.43 3,245.79 # 20206 68.69 65.26 75.05 20827 2,764.97 2,626.72 3,020.73 20220 255.93 243.13 279.60 20838 2,640.70 2,508.67 2,884.97 # 20220 87.03 82.68 95.08 20900 621.06 590.01 678.51 20225 1,174.64 1,115.91 1,283.30 # 20900 497.74 472.85 543.78 # 20225 129.55 123.07 141.53 20902 638.70 606.77 697.79 20240 252.63 240.00 276.00 20910 460.01 437.01 502.56 20245 634.09 602.39 692.75 20912 526.05 499.75 574.71 20250 381.16 362.10 416.42 20920 414.09 393.39 452.40 20251 434.97 413.22 475.20 20922 614.65 583.92 671.51 20500 152.73 145.09 166.85 # 20922 494.91 470.16 540.68 # 20500 119.66 113.68 130.73 20924 545.00 517.75 595.41 20501 161.21 153.15 176.12 20926 452.26 429.65 494.10 # 20501 41.91 39.81 45.78 20931 124.19 117.98 135.68 20520 208.46 198.04 227.75 20937 188.71 179.27 206.16 # 20520 157.08 149.23 171.61 20938 205.40 195.13 224.40 20525 560.07 532.07 611.88 20950 361.24 343.18 394.66 # 20525 267.86 254.47 292.64 # 20950 98.96 94.01 108.11 20526 83.63 79.45 91.37 20955 2,750.65 2,613.12 3,005.09 # 20526 63.52 60.34 69.39 20956 2,833.76 2,692.07 3,095.88 20550 63.48 60.31 69.36 20957 2,628.61 2,497.18 2,871.76 # 20550 42.03 39.93 45.92 20962 2,900.77 2,755.73 3,169.09 20551 61.86 58.77 67.59 20969 3,036.83 2,884.99 3,317.74 # 20551 46.22 43.91 50.50 20970 2,998.45 2,848.53 3,275.81 20552 59.29 56.33 64.78 20972 2,744.15 2,606.94 2,997.98 # 20552 36.06 34.26 39.40 20973 3,063.53 2,910.35 3,346.90 20553 66.99 63.64 73.19 20974 58.09 55.19 63.47 # 20553 40.18 38.17 43.90 # 20974 51.38 48.81 56.13 20600 57.01 54.16 62.28 20975 192.08 182.48 209.85 # 20600 43.61 41.43 47.64 20979 62.44 59.32 68.22 20605 62.71 59.57 68.51 # 20979 41.88 39.79 45.76 # 20605 44.83 42.59 48.98 20982 5,211.36 4,950.79 5,693.41 20610 76.33 72.51 83.39 # 20982 435.83 414.04 476.15 # 20610 52.64 50.01 57.51 21010 743.24 706.08 811.99 20612 61.81 58.72 67.53 21015 449.74 427.25 491.34 # 20612 46.18 43.87 50.45 21025 977.05 928.20 1,067.43 20615 251.74 239.15 275.02 # 21025 847.47 805.10 925.87 # 20615 177.12 168.26 193.50 21026 557.56 529.68 609.13 20650 201.51 191.43 220.14 # 21026 488.76 464.32 533.97 # 20650 164.87 156.63 180.12 21029 746.49 709.17 815.55 20660 251.15 238.59 274.38 # 21029 640.59 608.56 699.84 # 20660 186.36 177.04 203.60 21030 473.88 450.19 517.72 20661 442.09 419.99 482.99 # 21030 415.34 394.57 453.76 20662 499.41 474.44 545.61 21031 371.21 352.65 405.55 20663 453.92 431.22 495.90 # 21031 301.95 286.85 329.88 20664 678.13 644.22 740.85 21032 378.97 360.02 414.02 20665 152.90 145.26 167.05 # 21032 296.76 281.92 324.21 # 20665 116.71 110.87 127.50 21034 1,390.95 1,321.40 1,519.61 20670 592.64 563.01 647.46 # 21034 1,244.85 1,182.61 1,360.00 # 20670 169.96 161.46 185.68 21040 476.56 452.73 520.64 20680 539.55 512.57 589.46 # 21040 401.49 381.42 438.63 # 20680 312.57 296.94 341.48 21044 912.85 867.21 997.29 20690 265.98 252.68 290.58 21045 1,225.64 1,164.36 1,339.01 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 31146 PAGE 9 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 1,090.89 1,036.35 1,191.80 21179 1,577.74 1,498.85 1,723.68 21047 1,391.38 1,321.81 1,520.08 21180 1,766.91 1,678.56 1,930.34 21048 1,118.56 1,062.63 1,222.02 21181 756.73 718.89 826.72 21049 1,328.45 1,262.03 1,451.33 21182 2,187.62 2,078.24 2,389.98 21050 883.38 839.21 965.09 21183 2,433.11 2,311.45 2,658.17 21060 822.28 781.17 898.35 21184 2,631.14 2,499.58 2,874.52 21070 673.01 639.36 735.26 21188 1,766.86 1,678.52 1,930.30 21076 1,131.75 1,075.16 1,236.43 21193 1,296.85 1,232.01 1,416.81 # 21076 1,026.31 974.99 1,121.24 21194 1,444.88 1,372.64 1,578.54 21077 2,845.08 2,702.83 3,108.25 21195 1,380.68 1,311.65 1,508.40 # 21077 2,606.48 2,476.16 2,847.58 21196 1,497.19 1,422.33 1,635.68 21079 1,921.31 1,825.24 2,099.03 21198 1,160.71 1,102.67 1,268.07 # 21079 1,726.50 1,640.18 1,886.21 21199 1,070.14 1,016.63 1,169.12 21080 2,179.12 2,070.16 2,380.68 21206 1,152.15 1,094.54 1,258.72 # 21080 1,949.46 1,851.99 2,129.79 21208 1,428.91 1,357.46 1,561.08 21081 1,979.50 1,880.53 2,162.61 # 21208 857.89 815.00 937.25 # 21081 1,764.14 1,675.93 1,927.32 21209 770.69 732.16 841.98 21082 1,766.40 1,678.08 1,929.79 # 21209 648.26 615.85 708.23 # 21082 1,604.66 1,524.43 1,753.09 21210 1,548.77 1,471.33 1,692.03 21083 1,673.73 1,590.04 1,828.55 # 21210 853.53 810.85 932.48 # 21083 1,478.47 1,404.55 1,615.23 21215 2,338.55 2,221.62 2,554.86 21084 1,942.58 1,845.45 2,122.27 # 21215 881.50 837.43 963.04 # 21084 1,730.35 1,643.83 1,890.40 21230 815.31 774.54 890.72 21085 757.35 719.48 827.40 21235 719.61 683.63 786.17 # 21085 689.88 655.39 753.70 # 21235 565.91 537.61 618.25 21086 2,137.76 2,030.87 2,335.50 21240 1,149.50 1,092.03 1,255.83 # 21086 1,944.73 1,847.49 2,124.61 21242 1,069.54 1,016.06 1,168.47 21087 2,109.59 2,004.11 2,304.73 21243 1,681.44 1,597.37 1,836.98 # 21087 1,926.40 1,830.08 2,104.59 21244 1,038.50 986.58 1,134.57 21100 690.12 655.61 753.95 21245 1,140.02 1,083.02 1,245.47 # 21100 385.84 366.55 421.53 # 21245 936.27 889.46 1,022.88 21110 651.38 618.81 711.63 21246 928.36 881.94 1,014.23 # 21110 597.31 567.44 652.56 21247 1,737.71 1,650.82 1,898.44 21116 227.16 215.80 248.17 21248 1,033.94 982.24 1,129.58 # 21116 47.99 45.59 52.43 # 21248 911.51 865.93 995.82 21120 682.66 648.53 745.81 21249 1,500.61 1,425.58 1,639.42 # 21120 544.15 516.94 594.48 # 21249 1,320.10 1,254.10 1,442.22 21121 758.72 720.78 828.90 21255 1,440.27 1,368.26 1,573.50 # 21121 672.93 639.28 735.17 21256 1,201.73 1,141.64 1,312.89 21122 747.75 710.36 816.91 21260 1,242.09 1,179.99 1,356.99 21123 957.37 909.50 1,045.93 21261 2,407.04 2,286.69 2,629.69 21125 2,909.68 2,764.20 3,178.83 21263 2,034.27 1,932.56 2,222.44 # 21125 807.88 767.49 882.61 21267 1,669.11 1,585.65 1,823.50 21127 2,393.01 2,273.36 2,614.36 21268 1,960.75 1,862.71 2,142.12 # 21127 898.88 853.94 982.03 21270 939.94 892.94 1,026.88 21137 765.68 727.40 836.51 # 21270 742.90 705.76 811.62 21138 950.34 902.82 1,038.24 21275 838.98 797.03 916.58 21139 1,097.19 1,042.33 1,198.68 21280 511.78 486.19 559.12 21141 1,381.93 1,312.83 1,509.75 21282 343.53 326.35 375.30 21142 1,373.35 1,304.68 1,500.38 21295 177.61 168.73 194.04 21143 1,449.62 1,377.14 1,583.71 21296 394.60 374.87 431.10 21145 1,478.60 1,404.67 1,615.37 21300 137.61 130.73 150.34 21146 1,579.54 1,500.56 1,725.64 # 21300 43.33 41.16 47.33 21147 1,573.08 1,494.43 1,718.59 21310 126.33 120.01 138.01 21150 1,804.75 1,714.51 1,971.69 # 21310 30.71 29.17 33.55 21151 2,194.38 2,084.66 2,397.36 21315 252.22 239.61 275.55 21154 2,293.15 2,178.49 2,505.26 # 21315 147.22 139.86 160.84 21155 2,597.96 2,468.06 2,838.27 21320 252.30 239.69 275.64 21159 3,182.27 3,023.16 3,476.63 # 21320 149.53 142.05 163.36 21160 3,153.93 2,996.23 3,445.66 21325 541.27 514.21 591.34 21172 1,797.74 1,707.85 1,964.03 21330 659.75 626.76 720.77 21175 2,223.61 2,112.43 2,429.29 21335 787.08 747.73 859.89 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 31146 PAGE 10 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21336 668.69 635.26 730.55 21485 537.61 510.73 587.34 21337 387.43 368.06 423.27 # 21485 512.59 486.96 560.00 # 21337 273.04 259.39 298.30 21490 950.83 903.29 1,038.78 21338 902.62 857.49 986.11 21495 611.36 580.79 667.91 21339 964.71 916.47 1,053.94 21497 542.54 515.41 592.72 21340 827.45 786.08 903.99 # 21497 506.35 481.03 553.18 21343 1,238.19 1,176.28 1,352.72 21501 447.91 425.51 489.34 21344 1,575.08 1,496.33 1,720.78 # 21501 331.30 314.74 361.95 21345 784.46 745.24 857.03 21502 556.79 528.95 608.29 # 21345 664.71 631.47 726.19 21510 499.58 474.60 545.79 21346 993.59 943.91 1,085.50 21550 245.17 232.91 267.85 21347 1,260.68 1,197.65 1,377.30 # 21550 161.62 153.54 176.57 21348 1,216.72 1,155.88 1,329.26 21555 431.96 410.36 471.91 21355 435.33 413.56 475.59 # 21555 327.85 311.46 358.18 # 21355 312.01 296.41 340.87 21556 418.58 397.65 457.30 21356 493.28 468.62 538.91 21557 615.95 585.15 672.92 # 21356 378.00 359.10 412.97 21600 552.87 525.23 604.01 21360 538.00 511.10 587.77 21610 1,052.18 999.57 1,149.51 21365 1,114.54 1,058.81 1,217.63 21615 724.38 688.16 791.38 21366 1,268.91 1,205.46 1,386.28 21616 879.96 835.96 961.35 21385 754.67 716.94 824.48 21620 559.41 531.44 611.16 21386 700.61 665.58 765.42 21627 576.06 547.26 629.35 21387 809.20 768.74 884.05 21630 1,279.04 1,215.09 1,397.35 21390 768.65 730.22 839.75 21632 1,278.01 1,214.11 1,396.23 21395 938.18 891.27 1,024.96 21685 982.38 933.26 1,073.25 21400 175.84 167.05 192.11 21700 448.62 426.19 490.12 # 21400 142.77 135.63 155.97 21705 664.15 630.94 725.58 21401 495.62 470.84 541.47 21720 356.92 339.07 389.93 # 21401 294.10 279.40 321.31 21725 550.01 522.51 600.89 21406 565.85 537.56 618.19 21740 1,090.16 1,035.65 1,191.00 21407 668.95 635.50 730.83 21750 738.66 701.73 806.99 21408 920.24 874.23 1,005.36 21800 99.81 94.82 109.04 21421 638.66 606.73 697.74 21805 261.28 248.22 285.45 # 21421 592.63 563.00 647.45 21810 515.88 490.09 563.60 21422 713.58 677.90 779.59 21820 136.14 129.33 148.73 21423 857.97 815.07 937.33 # 21820 133.46 126.79 145.81 21431 720.71 684.67 787.37 21825 606.00 575.70 662.06 21432 718.91 682.96 785.40 21920 231.20 219.64 252.59 21433 1,799.43 1,709.46 1,965.88 # 21920 149.88 142.39 163.75 21435 1,295.93 1,231.13 1,415.80 21925 422.90 401.76 462.02 21436 1,994.29 1,894.58 2,178.77 # 21925 336.67 319.84 367.82 21440 434.03 412.33 474.18 21930 469.04 445.59 512.43 # 21440 392.03 372.43 428.29 # 21930 365.38 347.11 399.18 21445 668.18 634.77 729.99 21935 1,199.34 1,139.37 1,310.28 # 21445 606.08 575.78 662.15 22010 877.38 833.51 958.54 21450 455.65 432.87 497.80 22015 869.85 826.36 950.31 # 21450 432.86 411.22 472.90 22100 776.08 737.28 847.87 21451 626.21 594.90 684.14 22101 782.54 743.41 854.92 # 21451 583.32 554.15 637.27 22102 797.78 757.89 871.57 21452 668.29 634.88 730.11 22103 157.63 149.75 172.21 # 21452 291.18 276.62 318.11 22110 983.99 934.79 1,075.01 21453 717.52 681.64 783.89 22112 984.87 935.63 1,075.97 # 21453 717.08 681.23 783.41 22114 987.08 937.73 1,078.39 21454 555.00 527.25 606.34 22116 156.76 148.92 171.26 21461 1,438.45 1,366.53 1,571.51 22210 1,770.14 1,681.63 1,933.87 # 21461 909.87 864.38 994.04 22212 1,460.08 1,387.08 1,595.14 21462 1,654.05 1,571.35 1,807.05 22214 1,485.66 1,411.38 1,623.09 # 21462 986.51 937.18 1,077.76 22216 411.59 391.01 449.66 21465 945.17 897.91 1,032.60 22220 1,584.39 1,505.17 1,730.95 21470 1,190.52 1,130.99 1,300.64 22222 1,452.03 1,379.43 1,586.34 21480 104.99 99.74 114.70 22224 1,592.23 1,512.62 1,739.51 # 21480 33.95 32.25 37.09 22226 409.80 389.31 447.71 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 31146 PAGE 11 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 22305 194.52 184.79 212.51 23020 729.62 693.14 797.11 # 22305 177.10 168.25 193.49 23030 480.40 456.38 524.84 22310 241.33 229.26 263.65 # 23030 279.33 265.36 305.16 # 22310 221.23 210.17 241.70 23031 471.80 448.21 515.44 22315 830.02 788.52 906.80 # 23031 241.70 229.62 264.06 # 22315 724.57 688.34 791.59 23035 746.90 709.56 815.99 22318 1,584.94 1,505.69 1,731.54 23040 755.23 717.47 825.09 22319 1,762.52 1,674.39 1,925.55 23044 600.15 570.14 655.66 22325 1,361.98 1,293.88 1,487.96 23065 205.33 195.06 224.32 22326 1,455.89 1,383.10 1,590.57 # 23065 166.46 158.14 181.86 22327 1,413.10 1,342.45 1,543.82 23066 523.04 496.89 571.42 22328 307.14 291.78 335.55 # 23066 357.72 339.83 390.80 22505 125.00 118.75 136.56 23075 266.68 253.35 291.35 22520 3,158.03 3,000.13 3,450.15 # 23075 182.68 173.55 199.58 # 22520 623.27 592.11 680.93 23076 577.60 548.72 631.03 22521 2,877.59 2,733.71 3,143.77 23077 1,149.30 1,091.84 1,255.62 # 22521 591.26 561.70 645.96 23100 517.20 491.34 565.04 22522 265.71 252.42 290.28 23101 483.11 458.95 527.79 22523 653.12 620.46 713.53 23105 679.30 645.34 742.14 22524 626.18 594.87 684.10 23106 515.29 489.53 562.96 22525 296.32 281.50 323.73 23107 708.53 673.10 774.07 22532 1,719.78 1,633.79 1,878.86 23120 600.82 570.78 656.40 22533 1,597.38 1,517.51 1,745.14 23125 749.79 712.30 819.15 22534 404.44 384.22 441.85 23130 649.87 617.38 709.99 22548 1,870.16 1,776.65 2,043.15 23140 532.62 505.99 581.89 22554 1,402.86 1,332.72 1,532.63 23145 729.08 692.63 796.52 22556 1,694.72 1,609.98 1,851.48 23146 661.30 628.24 722.48 22558 1,551.25 1,473.69 1,694.74 23150 677.29 643.43 739.94 22585 375.40 356.63 410.12 23155 826.28 784.97 902.72 22590 1,529.59 1,453.11 1,671.08 23156 710.71 675.17 776.45 22595 1,453.35 1,380.68 1,587.78 23170 568.32 539.90 620.89 22600 1,234.22 1,172.51 1,348.39 23172 578.39 549.47 631.89 22610 1,233.74 1,172.05 1,347.86 23174 791.06 751.51 864.24 22612 1,578.98 1,500.03 1,725.03 23180 776.40 737.58 848.22 22614 439.54 417.56 480.19 23182 738.67 701.74 807.00 22630 1,553.26 1,475.60 1,696.94 23184 828.32 786.90 904.94 22632 355.37 337.60 388.24 23190 591.24 561.68 645.93 22800 1,387.93 1,318.53 1,516.31 23195 776.01 737.21 847.79 22802 2,252.48 2,139.86 2,460.84 23200 915.22 869.46 999.88 22804 2,624.83 2,493.59 2,867.63 23210 945.79 898.50 1,033.28 22808 1,891.14 1,796.58 2,066.07 23220 1,121.17 1,065.11 1,224.88 22810 2,144.55 2,037.32 2,342.92 23221 1,300.96 1,235.91 1,421.30 22812 2,319.86 2,203.87 2,534.45 23222 1,748.73 1,661.29 1,910.48 22818 2,265.34 2,152.07 2,474.88 23330 243.71 231.52 266.25 22819 2,531.94 2,405.34 2,766.14 # 23330 163.29 155.13 178.40 22830 843.05 800.90 921.04 23331 627.21 595.85 685.23 22840 857.02 814.17 936.30 23332 926.64 880.31 1,012.36 22842 857.90 815.01 937.26 23350 195.69 185.91 213.80 22843 899.75 854.76 982.97 # 23350 55.40 52.63 60.52 22844 1,121.66 1,065.58 1,225.42 23395 1,314.28 1,248.57 1,435.86 22845 817.63 776.75 893.26 23397 1,213.96 1,153.26 1,326.25 22846 849.99 807.49 928.61 23400 1,042.57 990.44 1,139.01 22847 935.71 888.92 1,022.26 23405 676.67 642.84 739.27 22848 408.32 387.90 446.09 23406 845.84 803.55 924.08 22849 1,355.09 1,287.34 1,480.44 23410 966.50 918.18 1,055.91 22850 741.23 704.17 809.80 23412 1,026.13 974.82 1,121.04 22851 453.61 430.93 495.57 23415 794.70 754.97 868.22 22852 708.20 672.79 773.71 23420 1,068.19 1,014.78 1,167.00 22855 1,120.59 1,064.56 1,224.24 23430 800.01 760.01 874.01 22900 391.32 371.75 427.51 23440 828.78 787.34 905.44 23000 570.67 542.14 623.46 23450 1,027.68 976.30 1,122.75 # 23000 386.58 367.25 422.34 23455 1,097.08 1,042.23 1,198.56 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 31146 PAGE 12 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 23460 1,182.38 1,123.26 1,291.75 # 23931 175.04 166.29 191.23 23462 1,149.98 1,092.48 1,256.35 23935 531.43 504.86 580.59 23465 1,195.41 1,135.64 1,305.99 24000 496.32 471.50 542.23 23466 1,131.94 1,075.34 1,236.64 24006 751.78 714.19 821.32 23470 1,300.13 1,235.12 1,420.39 24065 229.70 218.22 250.95 23472 1,569.70 1,491.22 1,714.90 # 24065 164.02 155.82 179.19 23480 882.67 838.54 964.32 24066 625.48 594.21 683.34 23485 1,031.37 979.80 1,126.77 # 24066 410.12 389.61 448.05 23490 892.34 847.72 974.88 24075 497.42 472.55 543.43 23491 1,102.06 1,046.96 1,204.00 # 24075 320.48 304.46 350.13 23500 218.17 207.26 238.35 24076 489.43 464.96 534.70 # 23500 202.54 192.41 221.27 24077 852.60 809.97 931.47 23505 358.06 340.16 391.18 24100 418.05 397.15 456.72 # 23505 332.59 315.96 363.35 24101 533.32 506.65 582.65 23515 617.94 587.04 675.10 24102 657.35 624.48 718.15 23520 221.53 210.45 242.02 24105 354.05 336.35 386.80 # 23520 216.61 205.78 236.65 24110 622.08 590.98 679.63 23525 356.13 338.32 389.07 24115 744.91 707.66 813.81 # 23525 329.32 312.85 359.78 24116 923.72 877.53 1,009.16 23530 584.09 554.89 638.12 24120 555.11 527.35 606.45 23532 662.90 629.76 724.22 24125 613.01 582.36 669.71 23540 223.29 212.13 243.95 24126 670.62 637.09 732.65 # 23540 200.95 190.90 219.54 24130 542.30 515.19 592.47 23545 324.14 307.93 354.12 24134 821.69 780.61 897.70 # 23545 287.06 272.71 313.62 24136 673.29 639.63 735.57 23550 602.43 572.31 658.16 24138 699.52 664.54 764.22 23552 697.94 663.04 762.50 24140 807.77 767.38 882.49 23570 231.97 220.37 253.43 24145 691.19 656.63 755.12 # 23570 226.60 215.27 247.56 24147 715.16 679.40 781.31 23575 392.91 373.26 429.25 24149 1,138.95 1,082.00 1,244.30 # 23575 367.44 349.07 401.43 24150 1,029.32 977.85 1,124.53 23585 734.36 697.64 802.29 24151 1,194.84 1,135.10 1,305.37 23600 331.43 314.86 362.09 24152 779.15 740.19 851.22 # 23600 286.75 272.41 313.27 24153 719.44 683.47 785.99 23605 488.71 464.27 533.91 24155 886.56 842.23 968.56 # 23605 441.79 419.70 482.66 24160 650.06 617.56 710.19 23615 805.43 765.16 879.93 24164 530.07 503.57 579.11 23616 1,565.10 1,486.85 1,709.88 24200 227.02 215.67 248.02 23620 266.52 253.19 291.17 # 24200 147.04 139.69 160.64 # 23620 238.38 226.46 260.43 24201 637.23 605.37 696.18 23625 392.78 373.14 429.11 # 24201 387.01 367.66 422.81 # 23625 363.29 345.13 396.90 24220 215.93 205.13 235.90 23630 618.89 587.95 676.14 # 24220 72.95 69.30 79.70 23650 309.03 293.58 337.62 24300 420.06 399.06 458.92 # 23650 263.91 250.71 288.32 24301 809.79 769.30 884.70 23655 383.87 364.68 419.38 24305 622.98 591.83 680.60 23660 613.74 583.05 670.51 24310 509.87 484.38 557.04 23665 432.82 411.18 472.86 24320 796.75 756.91 870.45 # 23665 405.12 384.86 442.59 24330 771.71 733.12 843.09 23670 651.80 619.21 712.09 24331 852.76 810.12 931.64 23675 569.85 541.36 622.56 24332 627.92 596.52 686.00 # 23675 525.17 498.91 573.75 24340 658.11 625.20 718.98 23680 803.74 763.55 878.08 24341 700.50 665.48 765.30 23700 207.99 197.59 227.23 24342 846.70 804.37 925.03 23800 1,083.61 1,029.43 1,183.84 24343 741.97 704.87 810.60 23802 1,177.81 1,118.92 1,286.76 24344 1,127.25 1,070.89 1,231.52 23900 1,381.31 1,312.24 1,509.08 24345 736.44 699.62 804.56 23920 1,082.35 1,028.23 1,182.46 24346 1,118.36 1,062.44 1,221.81 23921 462.91 439.76 505.72 24350 478.89 454.95 523.19 23930 409.94 389.44 447.86 24351 524.02 497.82 572.49 # 23930 230.32 218.80 251.62 24352 558.15 530.24 609.78 23931 342.59 325.46 374.28 24354 557.91 530.01 609.51 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 31146 PAGE 13 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 24356 573.98 545.28 627.07 24802 1,064.52 1,011.29 1,162.98 24360 962.24 914.13 1,051.25 24900 733.10 696.45 800.92 24361 1,083.29 1,029.13 1,183.50 24920 727.65 691.27 794.96 24362 1,106.46 1,051.14 1,208.81 24925 579.75 550.76 633.37 24363 1,418.41 1,347.49 1,549.61 24930 770.02 731.52 841.25 24365 688.83 654.39 752.55 24931 804.53 764.30 878.95 24366 735.95 699.15 804.02 24935 1,024.71 973.47 1,119.49 24400 881.01 836.96 962.50 25000 454.65 431.92 496.71 24410 1,111.05 1,055.50 1,213.83 25001 336.25 319.44 367.36 24420 1,056.29 1,003.48 1,154.00 25020 684.96 650.71 748.32 24430 997.13 947.27 1,089.36 25023 1,230.69 1,169.16 1,344.53 24435 1,063.78 1,010.59 1,162.18 25024 742.73 705.59 811.43 24470 727.67 691.29 794.98 25025 1,141.72 1,084.63 1,247.32 24495 741.08 704.03 809.63 25028 592.47 562.85 647.28 24498 936.78 889.94 1,023.43 25031 533.43 506.76 582.77 24500 356.31 338.49 389.26 25035 930.31 883.79 1,016.36 # 24500 304.03 288.83 332.15 25040 638.82 606.88 697.91 24505 521.91 495.81 570.18 25065 226.08 214.78 247.00 # 24505 467.85 444.46 511.13 # 25065 167.10 158.75 182.56 24515 930.49 883.97 1,016.57 25066 494.90 470.16 540.68 24516 918.43 872.51 1,003.39 25075 424.89 403.65 464.20 24530 385.27 366.01 420.91 25076 639.75 607.76 698.92 # 24530 333.00 316.35 363.80 25077 961.42 913.35 1,050.35 24535 651.72 619.13 712.00 25085 556.87 529.03 608.38 # 24535 597.21 567.35 652.45 25100 404.55 384.32 441.97 24538 803.30 763.14 877.61 25101 467.54 444.16 510.78 24545 836.49 794.67 913.87 25105 580.52 551.49 634.21 24546 1,194.59 1,134.86 1,305.09 25107 651.56 618.98 711.83 24560 322.11 306.00 351.90 25110 485.71 461.42 530.63 # 24560 264.47 251.25 288.94 25111 357.07 339.22 390.10 24565 538.68 511.75 588.51 25112 431.30 409.74 471.20 # 24565 489.98 465.48 535.30 25115 1,008.83 958.39 1,102.15 24566 705.24 669.98 770.48 25116 896.80 851.96 979.75 24575 843.18 801.02 921.17 25118 446.40 424.08 487.69 24576 337.52 320.64 368.74 25119 602.46 572.34 658.19 # 24576 290.61 276.08 317.49 25120 806.99 766.64 881.64 24577 562.50 534.38 614.54 25125 896.40 851.58 979.32 # 24577 513.80 488.11 561.33 25126 912.65 867.02 997.07 24579 903.97 858.77 987.59 25130 514.84 489.10 562.47 24582 782.82 743.68 855.23 25135 633.24 601.58 691.82 24586 1,169.33 1,110.86 1,277.49 25136 556.58 528.75 608.06 24587 1,154.61 1,096.88 1,261.41 25145 816.45 775.63 891.97 24600 396.10 376.30 432.75 25150 675.70 641.92 738.21 # 24600 335.33 318.56 366.34 25151 890.92 846.37 973.33 24605 476.24 452.43 520.29 25170 1,159.89 1,101.90 1,267.19 24615 762.01 723.91 832.50 25210 560.51 532.48 612.35 24620 581.86 552.77 635.69 25215 732.85 696.21 800.64 24635 1,206.93 1,146.58 1,318.57 25230 500.87 475.83 547.20 24640 132.79 126.15 145.07 25240 535.29 508.53 584.81 # 24640 85.88 81.59 93.83 25246 213.18 202.52 232.90 24650 263.36 250.19 287.72 # 25246 80.47 76.45 87.92 # 24650 217.34 206.47 237.44 25248 601.74 571.65 657.40 24655 457.51 434.63 499.82 25250 558.66 530.73 610.34 # 24655 405.23 384.97 442.72 25251 762.74 724.60 833.29 24665 692.94 658.29 757.03 25259 419.66 398.68 458.48 24666 776.48 737.66 848.31 25260 933.53 886.85 1,019.88 24670 294.60 279.87 321.85 25263 931.80 885.21 1,017.99 # 24670 248.13 235.72 271.08 25265 1,067.14 1,013.78 1,165.85 24675 475.31 451.54 519.27 25270 799.00 759.05 872.91 # 24675 428.85 407.41 468.52 25272 878.44 834.52 959.70 24685 722.20 686.09 789.00 25274 989.19 939.73 1,080.69 24800 873.37 829.70 954.16 25275 707.27 671.91 772.70 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 31146 PAGE 14 FSY06 LOCALITY FEE SCHEDULE FOR AREA 17 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 ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 25280 877.45 833.58 958.62 25565 545.43 518.16 595.88 25290 900.38 855.36 983.66 # 25565 488.24 463.83 533.40 25295 827.65 786.27 904.21 25574 629.43 597.96 687.65 25300 756.42 718.60 826.39 25575 883.63 839.45 965.37 25301 724.26 688.05 791.26 25600 297.50 282.63 325.02 25310 934.83 888.09 1,021.30 # 25600 247.45 235.08 270.34 25312 1,036.84 985.00 1,132.75 25605 578.09 549.19 631.57 25315 1,086.34 1,032.02 1,186.82 # 25605 532.97 506.32 582.27 25316 1,255.60 1,192.82 1,371.74 25611 741.78 704.69 810.39 25320 974.46 925.74 1,064.60 25620 698.02 663.12 762.59 25332 906.40 861.08 990.24 25622 304.48 289.26 332.65 25335 1,074.34 1,020.62 1,173.71 # 25622 252.20 239.59 275.53 25337 937.23 890.37 1,023.93 25624 479.91 455.91 524.30 25350 1,008.82 958.38 1,102.14 # 25624 424.50 403.28 463.77 25355 1,098.79 1,043.85 1,200.43 25628 716.96 681.11 783.28 25360 989.30 939.84 1,080.82 25630 312.10 296.50 340.98 25365 1,243.98 1,181.78 1,359.05 # 25630 256.70 243.87 280.45 25370 1,304.25 1,239.04 1,424.90 25635 457.80 434.91 500.15 25375 1,306.86 1,241.52 1,427.75 # 25635 366.21 347.90 400.09 25390 1,104.15 1,048.94 1,206.28 25645 613.03 582.38 669.74 25391 1,335.03 1,268.28 1,458.52 25650 324.53 308.30 354.55 25392 1,317.25 1,251.39 1,439.10 # 25650 273.60 259.92 298.91 25393 1,483.04 1,408.89 1,620.22 25651 478.42 454.50 522.68 25394 810.25 769.74 885.20 25652 643.47 611.30 703.00 25400 1,156.46 1,098.64 1,263.44 25660 412.30 391.69 450.44 25405 1,398.74 1,328.80 1,528.12 25670 657.47 624.60 718.29 25415 1,320.42 1,254.40 1,442.56 25671 537.24 510.38 586.94 25420 1,527.56 1,451.18 1,668.86 25675 452.37 429.75 494.21 25425 1,530.92 1,454.37 1,672.53 # 25675 407.24 386.88 444.91 25426 1,428.87 1,357.43 1,561.04 25676 677.69 643.81 740.38 25430 724.64 688.41 791.67 25680 467.20 443.84 510.42 25431 835.74 793.95 913.04 25685 775.15 736.39 846.85 25440 873.25 829.59 954.03 25690 485.34 461.07 530.23 25441 1,008.30 957.89 1,101.57 25695 679.43 645.46 742.28 25442 863.17 820.01 943.01 25800 831.61 790.03 908.53 25443 835.82 794.03 913.13 25805 948.75 901.31 1,036.51 25444 886.64 842.31 968.66 25810 901.78 856.69 985.19 25445 778.72 739.78 850.75 25820 675.89 642.10 738.42 25446 1,247.57 1,185.19 1,362.97 25825 814.26 773.55 889.58 25447 836.45 794.63 913.82 25830 1,080.49 1,026.47 1,180.44 25449 1,104.13 1,048.92 1,206.26 25900 950.26 902.75 1,038.16 25450 801.20 761.14 875.31 25905 945.31 898.04 1,032.75 25455 882.97 838.82 964.64 25907 861.29 818.23 940.96 25490 1,026.86 975.52 1,121.85 25909 939.31 892.34 1,026.19 25491 1,080.63 1,026.60 1,180.59 25915 1,592.67 1,513.04 1,740.00 25492 1,225.33 1,164.06 1,338.67 25920 727.48 691.11 794.78 25500 265.28 252.02 289.82 25922 636.16 604.35 695.00 # 25500 226.85 215.51 247.84 25924 728.78 692.34 796.19 25505 521.07 495.02 569.27 25927 901.47 856.40 984.86 # 25505 471.03 447.48 514.60 25929 590.62 561.09 645.25 25515 736.30 699.49 804.41 25931 849.69 807.21 928.29 25520 581.35 552.28 635.12 26010 314.39 298.67 343.47 # 25520 545.60 518.32 596.07 # 26010 137.90 131.01 150.66 25525 983.55 934.37 1,074.53 26011 489.61 465.13 534.90 25526 1,171.64 1,113.06 1,280.02 # 26011 198.73 188.79 217.11 25530 259.46 246.49 283.46 26020 442.07 419.97 482.97 # 25530 219.24 208.28 239.52 26025 438.03 416.13 478.55 25535 494.38 469.66 540.11 26030 513.04 487.39 560.50 # 25535 462.21 439.10 504.97 26034 555.42 527.65 606.80 25545 732.63 696.00 800.40 26035 764.09 725.89 834.77 25560 270.25 256.74 295.25 26037 597.20 567.34 652.44 # 25560 221.55 210.47 242.04 26040 326.08 309.78 356.25 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 31146