1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 1 FSY06 LOCALITY FEE SCHEDULE FOR AREA 26 DATE 2/1/06 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 139.65 132.67 152.57 D0421 9.26 8.80 10.12 G0182 148.08 140.68 161.78 D0431 9.26 8.80 10.12 G0186 366.43 348.11 400.33 D0475 20.69 19.66 22.61 G0202 161.26 153.20 176.18 D0476 91.99 87.39 100.50 G0202 TC 121.98 115.88 133.26 D0477 67.47 64.10 73.72 G0202 26 39.29 37.33 42.93 D0478 113.58 107.90 124.09 G0204 168.76 160.32 184.37 D0479 146.60 139.27 160.16 G0204 TC 120.10 114.10 131.22 D0481 492.74 468.10 538.32 G0204 26 48.65 46.22 53.15 D0482 107.57 102.19 117.52 G0206 136.55 129.72 149.18 D0483 93.35 88.68 101.98 G0206 TC 97.26 92.40 106.26 D0484 89.07 84.62 97.31 G0206 26 39.29 37.33 42.93 # D0484 78.53 74.60 85.79 G0237 22.74 21.60 24.84 D0485 137.16 130.30 149.85 G0238 23.68 22.50 25.88 D7288 162.83 154.69 177.89 G0239 16.18 15.37 17.68 # D7288 109.17 103.71 119.27 G0245 72.93 69.28 79.67 D7321 359.17 341.21 392.39 # G0245 50.45 47.93 55.12 # D7321 282.59 268.46 308.73 G0246 43.65 41.47 47.69 D7511 294.88 280.14 322.16 # G0246 25.85 24.56 28.24 # D7511 236.19 224.38 258.04 G0247 44.67 42.44 48.81 D7521 169.04 160.59 184.68 # G0247 30.15 28.64 32.94 # D7521 108.97 103.52 119.05 G0248 310.92 295.37 339.68 G0101 42.71 40.57 46.66 G0249 186.32 177.00 203.55 # G0101 26.32 25.00 28.75 G0250 10.23 9.72 11.18 G0102 25.29 24.03 27.63 G0268 54.14 51.43 59.14 # G0102 9.83 9.34 10.74 # G0268 35.87 34.08 39.19 G0104 147.31 139.94 160.93 G0270 22.38 21.26 24.45 # G0104 63.93 60.73 69.84 G0271 8.79 8.35 9.60 G0105 443.99 421.79 485.06 G0275 14.84 14.10 16.22 # G0105 224.30 213.09 245.05 G0278 14.84 14.10 16.22 G0105 53 147.31 139.94 160.93 G0281 12.57 11.94 13.73 # G0105 53 63.93 60.73 69.84 G0283 12.57 11.94 13.73 G0106 164.85 156.61 180.10 G0288 504.90 479.66 551.61 G0106 TC 109.62 104.14 119.76 G0289 104.87 99.63 114.57 G0106 26 55.23 52.47 60.34 G0308 915.38 869.61 1,000.05 G0108 39.24 37.28 42.87 G0309 762.29 724.18 832.81 G0109 22.85 21.71 24.97 G0310 609.81 579.32 666.22 G0117 51.72 49.13 56.50 G0311 615.13 584.37 672.03 # G0117 26.90 25.56 29.39 G0312 512.37 486.75 559.76 G0118 31.85 30.26 34.80 G0313 409.82 389.33 447.73 # G0118 9.83 9.34 10.74 G0314 541.73 514.64 591.84 G0120 164.85 156.61 180.10 G0315 451.07 428.52 492.80 G0120 TC 109.62 104.14 119.76 G0316 360.63 342.60 393.99 G0120 26 55.23 52.47 60.34 G0317 340.04 323.04 371.50 G0121 443.99 421.79 485.06 G0318 283.16 269.00 309.35 # G0121 224.30 213.09 245.05 G0319 226.28 214.97 247.22 G0121 53 147.31 139.94 160.93 G0320 762.29 724.18 832.81 # G0121 53 63.93 60.73 69.84 G0321 512.37 486.75 559.76 G0124 24.21 23.00 26.45 G0322 451.07 428.52 492.80 G0127 18.73 17.79 20.46 G0323 283.16 269.00 309.35 # G0127 10.30 9.79 11.26 G0324 25.32 24.05 27.66 G0128 4.90 4.66 5.36 G0325 15.00 14.25 16.39 G0130 51.54 48.96 56.30 G0326 17.03 16.18 18.61 G0130 TC 39.28 37.32 42.92 G0327 9.59 9.11 10.48 G0130 26 12.26 11.65 13.40 G0329 9.27 8.81 10.13 G0141 24.21 23.00 26.45 # G0329 3.65 3.47 3.99 G0166 170.80 162.26 186.60 G0332 89.47 85.00 97.75 # G0166 4.51 4.28 4.92 G0341 560.21 532.20 612.03 G0168 109.59 104.11 119.73 # G0341 412.66 392.03 450.83 # G0168 29.02 27.57 31.71 G0342 768.61 730.18 839.71 G0179 66.60 63.27 72.76 G0343 1,263.59 1,200.41 1,380.47 G0180 86.36 82.04 94.35 G0344 109.06 103.61 119.15 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 26 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 78.61 74.68 85.88 11006 768.06 729.66 839.11 G0364 14.27 13.56 15.59 11008 313.07 297.42 342.03 # G0364 10.53 10.00 11.50 11010 510.79 485.25 558.04 G0365 206.20 195.89 225.27 # 11010 311.24 295.68 340.03 G0365 TC 191.46 181.89 209.17 11011 603.49 573.32 659.32 G0365 26 14.74 14.00 16.10 # 11011 330.41 313.89 360.97 G0366 31.64 30.06 34.57 11012 879.80 835.81 961.18 G0367 21.80 20.71 23.82 # 11012 491.49 466.92 536.96 G0368 9.83 9.34 10.74 11040 46.12 43.81 50.38 G0372 25.29 24.03 27.63 # 11040 31.60 30.02 34.52 # G0372 9.83 9.34 10.74 11041 66.66 63.33 72.83 G0375 13.98 13.28 15.27 # 11041 51.21 48.65 55.95 G0376 27.60 26.22 30.15 11042 94.02 89.32 102.72 # G0376 27.13 25.77 29.64 # 11042 69.20 65.74 75.60 M0064 30.79 29.25 33.64 11043 263.62 250.44 288.01 # M0064 20.48 19.46 22.38 # 11043 226.62 215.29 247.58 P3001 24.21 23.00 26.45 11044 344.37 327.15 376.22 Q0035 28.82 27.38 31.49 # 11044 311.58 296.00 340.40 Q0035 TC 18.99 18.04 20.75 11055 44.89 42.65 49.05 Q0035 26 9.83 9.34 10.74 # 11055 26.62 25.29 29.08 Q0091 46.61 44.28 50.92 11056 56.41 53.59 61.63 # Q0091 21.78 20.69 23.79 # 11056 37.21 35.35 40.65 Q0092 15.35 14.58 16.77 11057 69.23 65.77 75.64 R0070 174.06 165.36 190.16 # 11057 48.62 46.19 53.12 R0075 174.06 165.36 190.16 11100 91.38 86.81 99.83 0016T 366.43 348.11 400.33 # 11100 50.16 47.65 54.80 0024T 650.69 618.16 710.88 11101 32.25 30.64 35.24 0030T 26.60 25.27 29.06 # 11101 25.69 24.41 28.07 0067T 506.64 481.31 553.51 11200 80.33 76.31 87.76 0067T TC 439.23 417.27 479.86 # 11200 67.22 63.86 73.44 0067T 26 67.41 64.04 73.65 11201 19.58 18.60 21.39 0073T 851.12 808.56 929.84 # 11201 17.71 16.82 19.34 10021 154.56 146.83 168.85 11300 67.44 64.07 73.68 # 10021 78.68 74.75 85.96 # 11300 30.91 29.36 33.76 10022 172.10 163.50 188.03 11301 86.75 82.41 94.77 # 10022 72.33 68.71 79.02 # 11301 52.55 49.92 57.41 10040 95.36 90.59 104.18 11302 103.85 98.66 113.46 # 10040 85.05 80.80 92.92 # 11302 64.50 61.28 70.47 10060 106.86 101.52 116.75 11303 125.13 118.87 136.70 # 10060 93.75 89.06 102.42 # 11303 75.48 71.71 82.47 10061 189.17 179.71 206.67 11305 68.60 65.17 74.95 # 10061 173.71 165.02 189.77 # 11305 41.43 39.36 45.26 10080 195.50 185.73 213.59 11306 92.85 88.21 101.44 # 10080 101.82 96.73 111.24 # 11306 61.00 57.95 66.64 10081 295.80 281.01 323.16 11307 107.63 102.25 117.59 # 10081 174.94 166.19 191.12 # 11307 70.16 66.65 76.65 10120 154.26 146.55 168.53 11308 127.87 121.48 139.70 # 10120 97.58 92.70 106.61 # 11308 87.59 83.21 95.69 10121 282.22 268.11 308.33 11310 82.05 77.95 89.64 # 10121 201.19 191.13 219.80 # 11310 45.04 42.79 49.21 10140 150.20 142.69 164.09 11311 100.57 95.54 109.87 # 10140 127.25 120.89 139.02 # 11311 65.91 62.61 72.00 10160 127.03 120.68 138.78 11312 115.71 109.92 126.41 # 10160 102.67 97.54 112.17 # 11312 74.96 71.21 81.89 10180 240.88 228.84 263.17 11313 151.88 144.29 165.93 # 10180 194.04 184.34 211.99 # 11313 100.82 95.78 110.15 11000 53.21 50.55 58.13 11400 129.16 122.70 141.11 # 11000 36.35 34.53 39.71 # 11400 76.70 72.87 83.80 11001 23.98 22.78 26.20 11401 148.31 140.89 162.02 # 11001 18.35 17.43 20.04 # 11401 99.59 94.61 108.80 11004 611.38 580.81 667.93 11402 168.33 159.91 183.90 11005 834.89 793.15 912.12 # 11402 114.46 108.74 125.05 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 26 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 188.71 179.27 206.16 11624 305.33 290.06 333.57 # 11403 138.12 131.21 150.89 # 11624 213.05 202.40 232.76 11404 215.26 204.50 235.18 11626 401.72 381.63 438.87 # 11404 153.89 146.20 168.13 # 11626 296.80 281.96 324.25 11406 263.53 250.35 287.90 11640 181.48 172.41 198.27 # 11406 197.01 187.16 215.23 # 11640 108.87 103.43 118.94 11420 124.57 118.34 136.09 11641 232.36 220.74 253.85 # 11420 85.22 80.96 93.10 # 11641 162.09 153.99 177.09 11421 157.31 149.44 171.86 11642 268.09 254.69 292.89 # 11421 112.34 106.72 122.73 # 11642 188.46 179.04 205.90 11422 175.52 166.74 191.75 11643 309.34 293.87 337.95 # 11422 131.96 125.36 144.16 # 11643 223.15 211.99 243.79 11423 207.31 196.94 226.48 11644 390.59 371.06 426.72 # 11423 153.91 146.21 168.14 # 11644 286.13 271.82 312.59 11424 235.88 224.09 257.70 11646 525.09 498.84 573.67 # 11424 179.21 170.25 195.79 # 11646 417.83 396.94 456.48 11426 327.12 310.76 357.37 11719 19.10 18.15 20.87 # 11426 262.47 249.35 286.75 # 11719 10.66 10.13 11.65 11440 147.95 140.55 161.63 11720 29.91 28.41 32.67 # 11440 105.79 100.50 115.58 # 11720 19.61 18.63 21.42 11441 172.30 163.69 188.24 11721 44.30 42.09 48.40 # 11441 132.49 125.87 144.75 # 11721 33.53 31.85 36.63 11442 192.63 183.00 210.45 11730 97.59 92.71 106.62 # 11442 146.73 139.39 160.30 # 11730 69.48 66.01 75.91 11443 234.47 222.75 256.16 11732 45.48 43.21 49.69 # 11443 182.94 173.79 199.86 # 11732 35.17 33.41 38.42 11444 296.90 282.06 324.37 11740 41.71 39.62 45.56 # 11444 236.47 224.65 258.35 # 11740 32.34 30.72 35.33 11446 380.81 361.77 416.04 11750 182.49 173.37 199.38 # 11446 321.32 305.25 351.04 # 11750 163.28 155.12 178.39 11450 355.35 337.58 388.22 11752 257.80 244.91 281.65 # 11450 214.36 203.64 234.19 11755 129.94 123.44 141.96 11451 483.64 459.46 528.38 # 11755 92.46 87.84 101.02 # 11451 293.00 278.35 320.10 11760 192.70 183.07 210.53 11462 349.75 332.26 382.10 # 11760 153.35 145.68 167.53 # 11462 204.55 194.32 223.47 11762 261.63 248.55 285.83 11463 494.31 469.59 540.03 # 11762 236.34 224.52 258.20 # 11463 299.92 284.92 327.66 11765 113.78 108.09 124.30 11470 379.30 360.34 414.39 # 11765 65.53 62.25 71.59 # 11470 248.15 235.74 271.10 11770 277.68 263.80 303.37 11471 508.16 482.75 555.16 # 11770 184.47 175.25 201.54 # 11471 323.14 306.98 353.03 11771 516.41 490.59 564.18 11600 178.61 169.68 195.13 # 11771 406.80 386.46 444.43 # 11600 100.39 95.37 109.68 11772 657.55 624.67 718.37 11601 201.81 191.72 220.48 # 11772 543.26 516.10 593.52 # 11601 132.02 125.42 144.23 11900 51.55 48.97 56.32 11602 213.31 202.64 233.04 # 11900 30.94 29.39 33.80 # 11602 139.77 132.78 152.70 11901 63.35 60.18 69.21 11603 235.87 224.08 257.69 # 11901 48.83 46.39 53.35 # 11603 153.90 146.21 168.14 11920 245.55 233.27 268.26 11604 259.60 246.62 283.61 # 11920 122.82 116.68 134.18 # 11604 166.39 158.07 181.78 11921 272.07 258.47 297.24 11606 337.68 320.80 368.92 # 11921 145.60 138.32 159.07 # 11606 228.54 217.11 249.68 11922 75.13 71.37 82.08 11620 171.67 163.09 187.55 # 11922 33.44 31.77 36.54 # 11620 94.38 89.66 103.11 11950 88.48 84.06 96.67 11621 200.25 190.24 218.78 # 11950 53.35 50.68 58.28 # 11621 131.39 124.82 143.54 11951 120.40 114.38 131.54 11622 226.08 214.78 247.00 # 11951 74.50 70.78 81.40 # 11622 152.07 144.47 166.14 11952 159.13 151.17 173.85 11623 265.96 252.66 290.56 # 11952 103.86 98.67 113.47 # 11623 183.52 174.34 200.49 11954 196.29 186.48 214.45 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 26 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 123.69 117.51 135.14 # 12045 264.34 251.12 288.79 11960 890.87 846.33 973.28 12046 491.08 466.53 536.51 11970 602.30 572.19 658.02 # 12046 314.95 299.20 344.08 11971 523.17 497.01 571.56 12047 500.70 475.67 547.02 # 11971 273.03 259.38 298.29 # 12047 347.53 330.15 379.67 11976 157.91 150.01 172.51 12051 257.66 244.78 281.50 # 11976 109.20 103.74 119.30 # 12051 171.94 163.34 187.84 11980 113.28 107.62 123.76 12052 265.99 252.69 290.59 # 11980 87.99 83.59 96.13 # 12052 181.67 172.59 198.48 11981 141.96 134.86 155.09 12053 282.81 268.67 308.97 # 11981 94.19 89.48 102.90 # 12053 202.24 192.13 220.95 11982 167.24 158.88 182.71 12054 313.26 297.60 342.24 # 11982 114.78 109.04 125.40 # 12054 222.39 211.27 242.96 11983 244.90 232.66 267.56 12055 399.79 379.80 436.77 # 11983 206.49 196.17 225.60 # 12055 289.24 274.78 316.00 12001 165.25 156.99 180.54 12056 543.39 516.22 593.65 # 12001 108.11 102.70 118.11 # 12056 369.61 351.13 403.80 12002 175.06 166.31 191.26 12057 541.48 514.41 591.57 # 12002 121.19 115.13 132.40 # 12057 429.53 408.05 469.26 12004 204.51 194.28 223.42 13100 321.84 305.75 351.61 # 12004 142.68 135.55 155.88 # 13100 239.86 227.87 262.05 12005 254.39 241.67 277.92 13101 381.37 362.30 416.65 # 12005 178.04 169.14 194.51 # 13101 288.62 274.19 315.32 12006 315.34 299.57 344.51 13102 108.10 102.70 118.11 # 12006 226.81 215.47 247.79 # 13102 79.99 75.99 87.39 12007 356.73 338.89 389.72 13120 333.11 316.45 363.92 # 12007 262.58 249.45 286.87 # 13120 248.79 236.35 271.80 12011 174.99 166.24 191.18 13121 405.97 385.67 443.52 # 12011 111.29 105.73 121.59 # 13121 309.48 294.01 338.11 12013 191.29 181.73 208.99 13122 132.58 125.95 144.84 # 12013 128.05 121.65 139.90 # 13122 91.36 86.79 99.81 12014 225.56 214.28 246.42 13131 362.22 344.11 395.73 # 12014 154.36 146.64 168.64 # 13131 283.53 269.35 309.75 12015 282.57 268.44 308.71 13132 521.63 495.55 569.88 # 12015 194.04 184.34 211.99 # 13132 439.66 417.68 480.33 12016 333.74 317.05 364.61 13133 170.08 161.58 185.82 # 12016 238.19 226.28 260.22 # 13133 140.57 133.54 153.57 12017 290.17 275.66 317.01 13150 389.78 370.29 425.83 12018 345.31 328.04 377.25 # 13150 290.95 276.40 317.86 12020 292.92 278.27 320.01 13151 410.50 389.98 448.48 # 12020 203.92 193.72 222.78 # 13151 332.74 316.10 363.52 12021 166.50 158.18 181.91 13152 545.51 518.23 595.96 # 12021 146.83 139.49 160.41 # 13152 451.82 429.23 493.61 12031 197.66 187.78 215.95 13153 192.81 183.17 210.65 # 12031 135.36 128.59 147.88 # 13153 155.34 147.57 169.71 12032 282.91 268.76 309.07 13160 801.88 761.79 876.06 # 12032 186.89 177.55 204.18 14000 620.39 589.37 677.78 12034 273.35 259.68 298.63 # 14000 508.44 483.02 555.47 # 12034 191.38 181.81 209.08 14001 803.34 763.17 877.65 12035 392.16 372.55 428.43 # 14001 693.27 658.61 757.40 # 12035 249.29 236.83 272.35 14020 685.22 650.96 748.60 12036 439.10 417.15 479.72 # 14020 587.79 558.40 642.16 # 12036 297.64 282.76 325.17 14021 891.59 847.01 974.06 12037 492.67 468.04 538.25 # 14021 811.50 770.93 886.57 # 12037 345.59 328.31 377.56 14040 744.03 706.83 812.85 12041 219.19 208.23 239.46 # 14040 668.61 635.18 730.46 # 12041 152.67 145.04 166.80 14041 973.31 924.64 1,063.34 12042 266.69 253.36 291.36 # 14041 883.38 839.21 965.09 # 12042 181.90 172.81 198.73 14060 769.95 731.45 841.17 12044 283.63 269.45 309.87 # 14060 706.24 670.93 771.57 # 12044 207.75 197.36 226.96 14061 1,053.05 1,000.40 1,150.46 12045 404.39 384.17 441.80 # 14061 954.69 906.96 1,043.00 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 26 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 1,024.73 973.49 1,119.51 # 15221 78.65 74.72 85.93 # 14300 932.92 886.27 1,019.21 15240 866.30 822.99 946.44 14350 760.02 722.02 830.32 # 15240 760.44 722.42 830.78 15000 353.87 336.18 386.61 15241 195.96 186.16 214.08 # 15000 278.46 264.54 304.22 # 15241 123.83 117.64 135.29 15001 107.48 102.11 117.43 15260 898.03 853.13 981.10 # 15001 63.45 60.28 69.32 # 15260 821.21 780.15 897.17 15040 301.11 286.05 328.96 15261 221.45 210.38 241.94 # 15040 139.98 132.98 152.93 # 15261 160.56 152.53 175.41 15050 513.33 487.66 560.81 15300 324.43 308.21 354.44 # 15050 428.54 407.11 468.18 # 15300 278.99 265.04 304.80 15100 991.66 942.08 1,083.39 15301 66.26 62.95 72.39 # 15100 767.75 729.36 838.76 # 15301 62.98 59.83 68.80 15101 251.26 238.70 274.51 15320 375.18 356.42 409.88 # 15101 130.88 124.34 142.99 # 15320 324.12 307.91 354.10 15110 920.83 874.79 1,006.01 15321 98.69 93.76 107.82 # 15110 748.46 711.04 817.70 # 15321 94.01 89.31 102.71 15111 142.32 135.20 155.48 15330 323.96 307.76 353.92 # 15111 118.90 112.96 129.90 # 15330 278.52 264.59 304.28 15115 859.27 816.31 938.76 15331 65.79 62.50 71.88 # 15115 771.21 732.65 842.55 # 15331 62.98 59.83 68.80 15116 183.91 174.71 200.92 15335 359.23 341.27 392.46 # 15116 162.36 154.24 177.38 # 15335 310.98 295.43 339.74 15120 930.29 883.78 1,016.35 15336 95.59 90.81 104.43 # 15120 792.11 752.50 865.38 # 15336 89.97 85.47 98.29 15121 328.90 312.46 359.33 15340 348.43 331.01 380.66 # 15121 204.30 194.09 223.20 # 15340 289.88 275.39 316.70 15130 772.63 734.00 844.10 15341 50.34 47.82 54.99 # 15130 607.28 576.92 663.46 # 15341 31.13 29.57 34.01 15131 116.49 110.67 127.27 15360 377.05 358.20 411.93 # 15131 96.35 91.53 105.26 # 15360 311.94 296.34 340.79 15135 919.65 873.67 1,004.72 15361 77.29 73.43 84.44 # 15135 837.68 795.80 915.17 # 15361 71.67 68.09 78.30 15136 107.70 102.32 117.67 15365 392.85 373.21 429.19 # 15136 97.39 92.52 106.40 # 15365 329.15 312.69 359.59 15150 761.71 723.62 832.16 15366 95.75 90.96 104.60 # 15150 667.10 633.75 728.81 # 15366 90.13 85.62 98.46 15151 149.86 142.37 163.73 15400 361.65 343.57 395.11 # 15151 128.31 121.89 140.17 15401 133.25 126.59 145.58 15152 183.69 174.51 200.69 # 15401 64.86 61.62 70.86 # 15152 160.27 152.26 175.10 15420 419.51 398.53 458.31 15155 757.87 719.98 827.98 # 15420 373.13 354.47 407.64 # 15155 717.59 681.71 783.97 15421 128.20 121.79 140.06 15156 193.85 184.16 211.78 # 15421 95.41 90.64 104.24 # 15156 178.86 169.92 195.41 15430 573.32 544.65 626.35 15157 215.04 204.29 234.93 # 15430 559.74 531.75 611.51 # 15157 194.89 185.15 212.92 15570 939.67 892.69 1,026.59 15170 395.69 375.91 432.30 # 15570 726.54 690.21 793.74 # 15170 326.83 310.49 357.06 15572 852.18 809.57 931.01 15171 99.46 94.49 108.66 # 15572 709.31 673.84 774.92 # 15171 96.65 91.82 105.59 15574 931.82 885.23 1,018.01 15175 558.77 530.83 610.45 # 15574 795.98 756.18 869.61 # 15175 491.78 467.19 537.27 15576 829.70 788.22 906.45 15176 158.48 150.56 173.14 # 15576 694.79 660.05 759.06 # 15176 152.86 145.22 167.00 15600 441.54 419.46 482.38 15200 791.42 751.85 864.63 # 15600 228.41 216.99 249.54 # 15200 641.06 609.01 700.36 15610 327.64 311.26 357.95 15201 178.98 170.03 195.53 # 15610 268.15 254.74 292.95 # 15201 87.64 83.26 95.75 15620 493.22 468.56 538.84 15220 769.78 731.29 840.98 # 15620 310.07 294.57 338.76 # 15220 652.21 619.60 712.54 15630 471.13 447.57 514.71 15221 161.56 153.48 176.50 # 15630 335.29 318.53 366.31 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 26 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 505.75 480.46 552.53 # 15839 711.53 675.95 777.34 # 15650 368.03 349.63 402.07 15840 1,034.96 983.21 1,130.69 15732 1,617.21 1,536.35 1,766.80 15841 1,706.15 1,620.84 1,863.97 # 15732 1,343.66 1,276.48 1,467.95 15842 2,739.80 2,602.81 2,993.23 15734 1,640.94 1,558.89 1,792.72 15845 958.10 910.20 1,046.73 # 15734 1,371.61 1,303.03 1,498.48 15851 114.56 108.83 125.15 15736 1,581.61 1,502.53 1,727.91 # 15851 50.39 47.87 55.05 # 15736 1,252.32 1,189.70 1,368.16 15852 123.61 117.43 135.04 15738 1,640.93 1,558.88 1,792.71 # 15852 52.41 49.79 57.26 # 15738 1,347.23 1,279.87 1,471.85 15860 125.05 118.80 136.62 15740 899.56 854.58 982.77 # 15860 122.71 116.57 134.06 # 15740 811.50 770.93 886.57 15920 609.64 579.16 666.03 15750 922.52 876.39 1,007.85 15922 777.55 738.67 849.47 15756 2,511.10 2,385.55 2,743.38 15931 673.88 640.19 736.22 15757 2,533.32 2,406.65 2,767.65 15933 847.98 805.58 926.42 15758 2,539.58 2,412.60 2,774.49 15934 938.38 891.46 1,025.18 15760 843.58 801.40 921.61 15935 1,130.53 1,074.00 1,235.10 # 15760 713.83 678.14 779.86 15936 933.94 887.24 1,020.33 15770 646.09 613.79 705.86 15937 1,091.91 1,037.31 1,192.91 15775 372.19 353.58 406.62 15940 702.92 667.77 767.94 # 15775 234.48 222.76 256.17 15941 951.18 903.62 1,039.16 15776 494.27 469.56 539.99 15944 911.71 866.12 996.04 # 15776 374.35 355.63 408.97 15945 1,015.97 965.17 1,109.95 15780 850.51 807.98 929.18 15946 1,633.30 1,551.64 1,784.39 # 15780 696.88 662.04 761.35 15950 587.02 557.67 641.32 15781 526.56 500.23 575.26 15951 842.27 800.16 920.18 # 15781 453.96 431.26 495.95 15952 867.35 823.98 947.58 15782 643.98 611.78 703.55 15953 981.36 932.29 1,072.13 # 15782 488.93 464.48 534.15 15956 1,193.17 1,133.51 1,303.54 15783 500.58 475.55 546.88 15958 1,205.70 1,145.42 1,317.23 # 15783 374.10 355.40 408.71 16000 78.05 74.15 85.27 15786 240.91 228.86 263.19 # 16000 49.95 47.45 54.57 # 15786 145.36 138.09 158.80 16020 94.67 89.94 103.43 15787 65.43 62.16 71.48 # 16020 61.41 58.34 67.09 # 15787 21.87 20.78 23.90 16025 162.27 154.16 177.28 15788 401.12 381.06 438.22 # 16025 124.33 118.11 135.83 # 15788 230.62 219.09 251.95 16030 192.30 182.69 210.09 15789 579.52 550.54 633.12 # 16030 142.65 135.52 155.85 # 15789 424.94 403.69 464.24 16035 237.20 225.34 259.14 15792 410.63 390.10 448.62 16036 94.11 89.40 102.81 # 15792 286.50 272.18 313.01 17000 70.03 66.53 76.51 15793 448.13 425.72 489.58 # 17000 49.89 47.40 54.51 # 15793 358.67 340.74 391.85 17003 11.39 10.82 12.44 15819 739.50 702.53 807.91 # 17003 9.52 9.04 10.40 15820 543.30 516.14 593.56 17004 221.51 210.43 241.99 # 15820 477.25 453.39 521.40 # 17004 187.78 178.39 205.15 15821 585.24 555.98 639.38 17106 408.06 387.66 445.81 # 15821 508.42 483.00 555.45 # 17106 348.58 331.15 380.82 15822 461.38 438.31 504.06 17107 719.52 683.54 786.07 # 15822 398.15 378.24 434.98 # 17107 637.55 605.67 696.52 15823 662.59 629.46 723.88 17108 971.15 922.59 1,060.98 # 15823 596.07 566.27 651.21 # 17108 895.74 850.95 978.59 15831 931.55 884.97 1,017.72 17110 103.16 98.00 112.70 15832 904.99 859.74 988.70 # 17110 60.07 57.07 65.63 15833 855.53 812.75 934.66 17111 116.08 110.28 126.82 15834 843.74 801.55 921.78 # 17111 75.80 72.01 82.81 15835 868.48 825.06 948.82 17250 78.91 74.96 86.20 15836 732.57 695.94 800.33 # 17250 37.69 35.81 41.18 15837 774.04 735.34 845.64 17260 97.06 92.21 106.04 # 15837 718.77 682.83 785.25 # 17260 68.49 65.07 74.83 15838 584.77 555.53 638.86 17261 123.07 116.92 134.46 15839 825.83 784.54 902.22 # 17261 86.53 82.20 94.53 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 26 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 152.61 144.98 166.73 19110 460.86 437.82 503.49 # 17262 111.86 106.27 122.21 # 19110 323.15 306.99 353.04 17263 169.17 160.71 184.82 19112 445.57 423.29 486.78 # 17263 123.73 117.54 135.17 # 19112 286.78 272.44 313.31 17264 183.37 174.20 200.33 19120 457.00 434.15 499.27 # 17264 131.38 124.81 143.53 # 19120 387.68 368.30 423.55 17266 212.52 201.89 232.17 19125 490.37 465.85 535.73 # 17266 152.10 144.50 166.18 # 19125 420.11 399.10 458.97 17270 133.16 126.50 145.48 19126 175.39 166.62 191.61 # 17270 94.29 89.58 103.02 19140 561.35 533.28 613.27 17271 143.93 136.73 157.24 # 19140 385.23 365.97 420.87 # 17271 106.46 101.14 116.31 19160 423.56 402.38 462.74 17272 165.57 157.29 180.88 19162 891.56 846.98 974.03 # 17272 123.88 117.69 135.34 19180 622.72 591.58 680.32 17273 186.74 177.40 204.01 19182 563.08 534.93 615.17 # 17273 139.90 132.91 152.85 19200 1,049.42 996.95 1,146.49 17274 225.49 214.22 246.35 19220 1,076.50 1,022.68 1,176.08 # 17274 172.56 163.93 188.52 19240 1,087.88 1,033.49 1,188.51 17276 269.36 255.89 294.27 19260 1,204.94 1,144.69 1,316.39 # 17276 209.87 199.38 229.29 19271 1,677.31 1,593.44 1,832.46 17280 123.07 116.92 134.46 19272 1,840.43 1,748.41 2,010.67 # 17280 85.60 81.32 93.52 19290 186.26 176.95 203.49 17281 159.40 151.43 174.14 # 19290 71.97 68.37 78.63 # 17281 120.99 114.94 132.18 19291 82.81 78.67 90.47 17282 184.01 174.81 201.03 # 19291 35.97 34.17 39.30 # 17282 140.92 133.87 153.95 19295 126.83 120.49 138.56 17283 226.87 215.53 247.86 19296 6,045.56 5,743.28 6,604.77 # 17283 177.22 168.36 193.61 # 19296 226.93 215.58 247.92 17284 267.73 254.34 292.49 19297 103.52 98.34 113.09 # 17284 212.93 202.28 232.62 19298 2,231.11 2,119.55 2,437.48 17286 354.29 336.58 387.07 # 19298 364.02 345.82 397.69 # 17286 296.67 281.84 324.12 19316 830.12 788.61 906.90 17304 695.18 660.42 759.48 19318 1,241.49 1,179.42 1,356.33 # 17304 475.49 451.72 519.48 19324 488.74 464.30 533.95 17305 298.34 283.42 325.93 19325 685.16 650.90 748.54 # 17305 178.42 169.50 194.93 19328 490.70 466.17 536.10 17306 299.28 284.32 326.97 19330 625.97 594.67 683.87 # 17306 178.89 169.95 195.44 19340 432.12 410.51 472.09 17307 282.88 268.74 309.05 19342 923.49 877.32 1,008.92 # 17307 179.36 170.39 195.95 19350 1,050.28 997.77 1,147.44 17310 114.19 108.48 124.75 # 19350 736.91 700.06 805.07 # 17310 59.86 56.87 65.40 19355 811.04 770.49 886.06 17340 48.92 46.47 53.44 # 19355 550.13 522.62 601.01 # 17340 48.45 46.03 52.93 19357 1,549.91 1,472.41 1,693.27 17360 125.66 119.38 137.29 19361 1,443.23 1,371.07 1,576.73 # 17360 98.96 94.01 108.11 19364 2,935.08 2,788.33 3,206.58 19000 129.02 122.57 140.96 19366 1,493.67 1,418.99 1,631.84 # 19000 50.33 47.81 54.98 19367 1,936.51 1,839.68 2,115.63 19001 29.61 28.13 32.35 19368 2,356.60 2,238.77 2,574.59 # 19001 24.46 23.24 26.73 19369 2,193.88 2,084.19 2,396.82 19020 453.21 430.55 495.13 19370 685.84 651.55 749.28 # 19020 281.31 267.24 307.33 19371 791.80 752.21 865.04 19030 197.64 187.76 215.92 19380 771.45 732.88 842.81 # 19030 86.63 82.30 94.65 19396 146.47 139.15 160.02 19100 153.45 145.78 167.65 # 19396 142.25 135.14 155.41 # 19100 75.22 71.46 82.18 20000 218.58 207.65 238.80 19101 349.97 332.47 382.34 # 20000 173.62 164.94 189.68 # 19101 228.65 217.22 249.80 20005 314.20 298.49 343.26 19102 263.30 250.14 287.66 # 20005 256.12 243.31 279.81 # 19102 114.35 108.63 124.92 20100 647.34 614.97 707.22 19103 695.05 660.30 759.35 20101 420.32 399.30 459.20 # 19103 213.06 202.41 232.77 # 20101 217.97 207.07 238.13 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 26 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 522.09 495.99 570.39 20692 465.81 442.52 508.90 # 20102 261.18 248.12 285.34 20693 520.42 494.40 568.56 20103 637.24 605.38 696.19 20694 523.68 497.50 572.13 # 20103 393.67 373.99 430.09 # 20694 378.00 359.10 412.97 20150 939.30 892.34 1,026.19 20802 2,732.04 2,595.44 2,984.76 20200 207.92 197.52 227.15 20805 3,743.35 3,556.18 4,089.61 # 20200 100.66 95.63 109.97 20808 4,643.57 4,411.39 5,073.10 20205 286.70 272.37 313.23 20816 3,149.16 2,991.70 3,440.46 # 20205 159.76 151.77 174.54 20822 2,777.25 2,638.39 3,034.15 20206 346.73 329.39 378.80 20824 3,093.86 2,939.17 3,380.05 # 20206 70.83 67.29 77.38 20827 2,879.11 2,735.15 3,145.42 20220 266.72 253.38 291.39 20838 2,707.27 2,571.91 2,957.70 # 20220 89.66 85.18 97.96 20900 648.06 615.66 708.01 20225 1,229.78 1,168.29 1,343.53 # 20900 518.78 492.84 566.77 # 20225 134.16 127.45 146.57 20902 665.67 632.39 727.25 20240 262.39 249.27 286.66 20910 478.11 454.20 522.33 20245 660.52 627.49 721.61 20912 545.53 518.25 595.99 20250 398.00 378.10 434.82 20920 429.69 408.21 469.44 20251 454.39 431.67 496.42 20922 638.06 606.16 697.08 20500 158.87 150.93 173.57 # 20922 512.52 486.89 559.92 # 20500 124.20 117.99 135.69 20924 567.50 539.13 620.00 20501 168.00 159.60 183.54 20926 470.73 447.19 514.27 # 20501 42.94 40.79 46.91 20931 130.04 123.54 142.07 20520 216.86 206.02 236.92 20937 196.77 186.93 214.97 # 20520 163.00 154.85 178.08 20938 214.55 203.82 234.39 20525 584.73 555.49 638.81 20950 377.94 359.04 412.90 # 20525 278.39 264.47 304.14 # 20950 102.98 97.83 112.50 20526 86.97 82.62 95.01 20955 2,851.04 2,708.49 3,114.76 # 20526 65.89 62.60 71.99 20956 2,952.06 2,804.46 3,225.13 20550 65.90 62.61 72.00 20957 2,734.96 2,598.21 2,987.94 # 20550 43.42 41.25 47.44 20962 3,019.27 2,868.31 3,298.56 20551 64.13 60.92 70.06 20969 3,142.62 2,985.49 3,433.31 # 20551 47.74 45.35 52.15 20970 3,115.73 2,959.94 3,403.93 20552 61.40 58.33 67.08 20972 2,840.68 2,698.65 3,103.45 # 20552 37.04 35.19 40.47 20973 3,172.51 3,013.88 3,465.96 20553 69.25 65.79 75.66 20974 60.59 57.56 66.19 # 20553 41.14 39.08 44.94 # 20974 53.57 50.89 58.52 20600 59.20 56.24 64.68 20975 200.42 190.40 218.96 # 20600 45.15 42.89 49.32 20979 65.02 61.77 71.04 20605 65.14 61.88 71.16 # 20979 43.48 41.31 47.51 # 20605 46.40 44.08 50.69 20982 5,455.82 5,183.03 5,960.48 20610 79.43 75.46 86.78 # 20982 449.42 426.95 490.99 # 20610 54.61 51.88 59.66 21010 769.74 731.25 840.94 20612 64.30 61.09 70.25 21015 467.35 443.98 510.58 # 20612 47.91 45.51 52.34 21025 1,016.36 965.54 1,110.37 20615 261.46 248.39 285.65 # 21025 880.52 836.49 961.96 # 20615 183.23 174.07 200.18 21026 580.46 551.44 634.16 20650 209.61 199.13 229.00 # 21026 508.33 482.91 555.35 # 20650 171.20 162.64 187.04 21029 776.03 737.23 847.81 20660 263.02 249.87 287.35 # 21029 665.01 631.76 726.52 # 20660 195.10 185.35 213.15 21030 492.91 468.26 538.50 20661 462.90 439.76 505.72 # 21030 431.55 409.97 471.47 20662 517.21 491.35 565.05 21031 386.95 367.60 422.74 20663 473.09 449.44 516.86 # 21031 314.35 298.63 343.42 20664 709.06 673.61 774.65 21032 395.02 375.27 431.56 20665 159.38 151.41 174.12 # 21032 308.84 293.40 337.41 # 20665 121.44 115.37 132.68 21034 1,442.73 1,370.59 1,576.18 20670 620.26 589.25 677.64 # 21034 1,289.56 1,225.08 1,408.84 # 20670 177.14 168.28 193.52 21040 495.72 470.93 541.57 20680 563.80 535.61 615.95 # 21040 417.03 396.18 455.61 # 20680 325.85 309.56 355.99 21044 944.76 897.52 1,032.15 20690 276.91 263.06 302.52 21045 1,268.17 1,204.76 1,385.47 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 26 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 1,134.34 1,077.62 1,239.26 21179 1,635.69 1,553.91 1,787.00 21047 1,441.63 1,369.55 1,574.98 21180 1,833.64 1,741.96 2,003.25 21048 1,161.92 1,103.82 1,269.39 21181 785.65 746.37 858.33 21049 1,373.41 1,304.74 1,500.45 21182 2,258.62 2,145.69 2,467.54 21050 917.98 872.08 1,002.89 21183 2,521.82 2,395.73 2,755.09 21060 854.22 811.51 933.24 21184 2,732.71 2,596.07 2,985.48 21070 700.36 665.34 765.14 21188 1,826.28 1,734.97 1,995.22 21076 1,177.40 1,118.53 1,286.31 21193 1,345.90 1,278.61 1,470.40 # 21076 1,066.86 1,013.52 1,165.55 21194 1,495.25 1,420.49 1,633.56 21077 2,956.82 2,808.98 3,230.33 21195 1,429.75 1,358.26 1,562.00 # 21077 2,706.69 2,571.36 2,957.06 21196 1,551.95 1,474.35 1,695.50 21079 1,998.02 1,898.12 2,182.84 21198 1,202.91 1,142.76 1,314.17 # 21079 1,793.80 1,704.11 1,959.73 21199 1,104.58 1,049.35 1,206.75 21080 2,267.64 2,154.26 2,477.40 21206 1,193.30 1,133.64 1,303.69 # 21080 2,026.88 1,925.54 2,214.37 21208 1,488.27 1,413.86 1,625.94 21081 2,058.47 1,955.55 2,248.88 # 21208 889.64 845.16 971.93 # 21081 1,832.69 1,741.06 2,002.22 21209 802.77 762.63 877.02 21082 1,837.80 1,745.91 2,007.80 # 21209 674.42 640.70 736.81 # 21082 1,668.23 1,584.82 1,822.54 21210 1,615.31 1,534.54 1,764.72 21083 1,741.73 1,654.64 1,902.84 # 21210 886.46 842.14 968.46 # 21083 1,537.03 1,460.18 1,679.21 21215 2,443.90 2,321.71 2,669.97 21084 2,013.65 1,912.97 2,199.92 # 21215 916.41 870.59 1,001.18 # 21084 1,791.15 1,701.59 1,956.83 21230 845.43 803.16 923.63 21085 787.45 748.08 860.29 21235 747.32 709.95 816.44 # 21085 716.72 680.88 783.01 # 21235 586.18 556.87 640.40 21086 2,224.37 2,113.15 2,430.12 21240 1,196.61 1,136.78 1,307.30 # 21086 2,022.02 1,920.92 2,209.06 21242 1,111.58 1,056.00 1,214.40 21087 2,193.06 2,083.41 2,395.92 21243 1,749.79 1,662.30 1,911.65 # 21087 2,001.01 1,900.96 2,186.10 21244 1,077.34 1,023.47 1,176.99 21100 718.75 682.81 785.23 21245 1,183.37 1,124.20 1,292.83 # 21100 399.76 379.77 436.74 # 21245 969.78 921.29 1,059.48 21110 679.01 645.06 741.82 21246 961.52 913.44 1,050.46 # 21110 622.33 591.21 679.89 21247 1,802.96 1,712.81 1,969.73 21116 237.20 225.34 259.14 21248 1,075.17 1,021.41 1,174.62 # 21116 49.37 46.90 53.94 # 21248 946.82 899.48 1,034.40 21120 711.47 675.90 777.29 21249 1,560.55 1,482.52 1,704.90 # 21120 566.27 537.96 618.65 # 21249 1,371.32 1,302.75 1,498.16 21121 788.70 749.27 861.66 21255 1,497.95 1,423.05 1,636.51 # 21121 698.76 663.82 763.39 21256 1,242.94 1,180.79 1,357.91 21122 776.87 738.03 848.73 21260 1,281.21 1,217.15 1,399.72 21123 994.44 944.72 1,086.43 21261 2,493.90 2,369.21 2,724.59 21125 3,038.01 2,886.11 3,319.03 21263 2,102.90 1,997.76 2,297.42 # 21125 834.59 792.86 911.79 21267 1,729.77 1,643.28 1,889.77 21127 2,500.35 2,375.33 2,731.63 21268 2,039.14 1,937.18 2,227.76 # 21127 933.97 887.27 1,020.36 21270 973.23 924.57 1,063.26 21137 795.16 755.40 868.71 # 21270 766.66 728.33 837.58 21138 987.61 938.23 1,078.96 21275 869.47 826.00 949.90 21139 1,133.86 1,077.17 1,238.75 21280 529.32 502.85 578.28 21141 1,434.31 1,362.59 1,566.98 21282 356.08 338.28 389.02 21142 1,424.34 1,353.12 1,556.09 21295 184.72 175.48 201.80 21143 1,498.28 1,423.37 1,636.88 21296 408.90 388.46 446.73 21145 1,535.84 1,459.05 1,677.91 21300 143.93 136.73 157.24 21146 1,642.03 1,559.93 1,793.92 # 21300 45.09 42.84 49.27 21147 1,625.26 1,544.00 1,775.60 21310 131.80 125.21 143.99 21150 1,867.08 1,773.73 2,039.79 # 21310 31.56 29.98 34.48 21151 2,268.84 2,155.40 2,478.71 21315 262.84 249.70 287.16 21154 2,369.91 2,251.41 2,589.12 # 21315 152.76 145.12 166.89 21155 2,710.38 2,574.86 2,961.09 21320 262.62 249.49 286.91 21159 3,319.99 3,153.99 3,627.09 # 21320 154.88 147.14 169.21 21160 3,256.85 3,094.01 3,558.11 21325 563.26 535.10 615.37 21172 1,862.09 1,768.99 2,034.34 21330 686.44 652.12 749.94 21175 2,308.11 2,192.70 2,521.61 21335 815.77 774.98 891.23 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 26 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 695.19 660.43 759.49 21485 560.37 532.35 612.20 21337 403.53 383.35 440.85 # 21485 534.14 507.43 583.54 # 21337 283.62 269.44 309.86 21490 990.12 940.61 1,081.70 21338 940.99 893.94 1,028.03 21495 634.55 602.82 693.24 21339 1,004.30 954.09 1,097.20 21497 565.69 537.41 618.02 21340 857.23 814.37 936.53 # 21497 527.75 501.36 576.56 21343 1,286.33 1,222.01 1,405.31 21501 466.11 442.80 509.22 21344 1,634.65 1,552.92 1,785.86 # 21501 343.86 326.67 375.67 21345 814.95 774.20 890.33 21502 578.34 549.42 631.83 # 21345 689.42 654.95 753.19 21510 519.52 493.54 567.57 21346 1,032.06 980.46 1,127.53 21550 254.67 241.94 278.23 21347 1,310.34 1,244.82 1,431.54 # 21550 167.07 158.72 182.53 21348 1,264.31 1,201.09 1,381.25 21555 449.35 426.88 490.91 21355 452.39 429.77 494.24 # 21555 340.21 323.20 371.68 # 21355 323.11 306.95 352.99 21556 433.89 412.20 474.03 21356 513.31 487.64 560.79 21557 638.16 606.25 697.19 # 21356 392.46 372.84 428.77 21600 574.73 545.99 627.89 21360 558.21 530.30 609.85 21610 1,099.14 1,044.18 1,200.81 21365 1,154.84 1,097.10 1,261.67 21615 752.63 715.00 822.25 21366 1,317.30 1,251.44 1,439.16 21616 914.87 869.13 999.50 21385 782.40 743.28 854.77 21620 581.69 552.61 635.50 21386 725.73 689.44 792.86 21627 599.38 569.41 654.82 21387 839.39 797.42 917.03 21630 1,329.16 1,262.70 1,452.11 21390 795.01 755.26 868.55 21632 1,327.28 1,260.92 1,450.06 21395 972.07 923.47 1,061.99 21685 1,015.37 964.60 1,109.29 21400 183.01 173.86 199.94 21700 462.18 439.07 504.93 # 21400 148.35 140.93 162.07 21705 689.81 655.32 753.62 21401 516.68 490.85 564.48 21720 370.78 352.24 405.08 # 21401 305.43 290.16 333.68 21725 573.02 544.37 626.03 21406 586.43 557.11 640.68 21740 1,131.13 1,074.57 1,235.76 21407 693.25 658.59 757.38 21750 767.32 728.95 838.29 21408 953.76 906.07 1,041.98 21800 103.64 98.46 113.23 21421 665.85 632.56 727.44 21805 271.86 258.27 297.01 # 21421 617.60 586.72 674.73 21810 535.68 508.90 585.24 21422 740.84 703.80 809.37 21820 141.66 134.58 154.77 21423 890.63 846.10 973.02 # 21820 138.85 131.91 151.70 21431 748.51 711.08 817.74 21825 630.36 598.84 688.67 21432 744.76 707.52 813.65 21920 239.89 227.90 262.09 21433 1,862.85 1,769.71 2,035.17 # 21920 154.64 146.91 168.95 21435 1,343.13 1,275.97 1,467.37 21925 439.88 417.89 480.57 21436 2,064.72 1,961.48 2,255.70 # 21925 349.48 332.01 381.81 21440 453.05 430.40 494.96 21930 487.80 463.41 532.92 # 21440 409.02 388.57 446.86 # 21930 379.13 360.17 414.20 21445 696.74 661.90 761.19 21935 1,243.92 1,181.72 1,358.98 # 21445 631.63 600.05 690.06 22010 912.91 867.26 997.35 21450 474.94 451.19 518.87 22015 905.06 859.81 988.78 # 21450 451.05 428.50 492.78 22100 811.55 770.97 886.62 21451 652.59 619.96 712.95 22101 816.67 775.84 892.22 # 21451 607.63 577.25 663.84 22102 832.45 790.83 909.45 21452 699.10 664.15 763.77 22103 164.28 156.07 179.48 # 21452 303.76 288.57 331.86 22110 1,028.70 977.27 1,123.86 21453 747.93 710.53 817.11 22112 1,027.92 976.52 1,123.00 # 21453 747.47 710.10 816.62 22114 1,030.96 979.41 1,126.32 21454 576.56 547.73 629.89 22116 163.79 155.60 178.94 21461 1,501.07 1,426.02 1,639.92 22210 1,852.22 1,759.61 2,023.55 # 21461 946.94 899.59 1,034.53 22212 1,524.28 1,448.07 1,665.28 21462 1,726.19 1,639.88 1,885.86 22214 1,551.11 1,473.55 1,694.58 # 21462 1,026.38 975.06 1,121.32 22216 430.01 408.51 469.79 21465 981.07 932.02 1,071.82 22220 1,659.02 1,576.07 1,812.48 21470 1,235.63 1,173.85 1,349.93 22222 1,513.81 1,438.12 1,653.84 21480 109.45 103.98 119.58 22224 1,661.19 1,578.13 1,814.85 # 21480 34.97 33.22 38.20 22226 428.14 406.73 467.74 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 26 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 203.10 192.95 221.89 23020 760.27 722.26 830.60 # 22305 184.84 175.60 201.94 23030 501.72 476.63 548.12 22310 251.98 239.38 275.29 # 23030 290.93 276.38 317.84 # 22310 230.90 219.36 252.26 23031 493.11 468.45 538.72 22315 867.73 824.34 947.99 # 23031 251.88 239.29 275.18 # 22315 757.18 719.32 827.22 23035 778.46 739.54 850.47 22318 1,660.83 1,577.79 1,814.46 23040 787.08 747.73 859.89 22319 1,847.82 1,755.43 2,018.74 23044 625.57 594.29 683.43 22325 1,423.09 1,351.94 1,554.73 23065 212.82 202.18 232.51 22326 1,523.04 1,446.89 1,663.92 # 23065 172.07 163.47 187.99 22327 1,475.92 1,402.12 1,612.44 23066 545.61 518.33 596.08 22328 320.57 304.54 350.22 # 23066 372.30 353.69 406.74 22505 130.32 123.80 142.37 23075 277.85 263.96 303.55 22520 3,307.25 3,141.89 3,613.17 # 23075 189.79 180.30 207.35 # 22520 649.94 617.44 710.06 23076 600.36 570.34 655.89 22521 3,013.47 2,862.80 3,292.22 23077 1,193.61 1,133.93 1,304.02 # 22521 616.60 585.77 673.64 23100 539.09 512.14 588.96 22522 276.84 263.00 302.45 23101 503.58 478.40 550.16 22523 679.32 645.35 742.15 23105 707.89 672.50 773.38 22524 651.28 618.72 711.53 23106 536.88 510.04 586.55 22525 307.99 292.59 336.48 23107 738.36 701.44 806.66 22532 1,791.87 1,702.28 1,957.62 23120 626.22 594.91 684.15 22533 1,657.14 1,574.28 1,810.42 23125 781.19 742.13 853.45 22534 422.31 401.19 461.37 23130 677.38 643.51 740.04 22548 1,954.75 1,857.01 2,135.56 23140 554.09 526.39 605.35 22554 1,469.25 1,395.79 1,605.16 23145 759.11 721.15 829.32 22556 1,766.49 1,678.17 1,929.90 23146 689.22 654.76 752.97 22558 1,610.17 1,529.66 1,759.11 23150 704.71 669.47 769.89 22585 392.66 373.03 428.98 23155 860.99 817.94 940.63 22590 1,601.15 1,521.09 1,749.25 23156 740.60 703.57 809.11 22595 1,520.57 1,444.54 1,661.22 23170 591.84 562.25 646.59 22600 1,291.73 1,227.14 1,411.21 23172 601.61 571.53 657.26 22610 1,290.10 1,225.60 1,409.44 23174 824.45 783.23 900.71 22612 1,650.00 1,567.50 1,802.63 23180 809.52 769.04 884.40 22614 459.25 436.29 501.73 23182 769.94 731.44 841.16 22630 1,625.02 1,543.77 1,775.34 23184 863.60 820.42 943.48 22632 371.56 352.98 405.93 23190 615.56 584.78 672.50 22800 1,449.58 1,377.10 1,583.67 23195 808.51 768.08 883.29 22802 2,350.89 2,233.35 2,568.35 23200 952.22 904.61 1,040.30 22804 2,737.78 2,600.89 2,991.02 23210 984.19 934.98 1,075.23 22808 1,971.58 1,873.00 2,153.95 23220 1,167.66 1,109.28 1,275.67 22810 2,232.02 2,120.42 2,438.48 23221 1,354.64 1,286.91 1,479.95 22812 2,412.76 2,292.12 2,635.94 23222 1,819.71 1,728.72 1,988.03 22818 2,364.76 2,246.52 2,583.50 23330 254.02 241.32 277.52 22819 2,644.54 2,512.31 2,889.16 # 23330 169.70 161.22 185.40 22830 880.97 836.92 962.46 23331 653.71 621.02 714.17 22840 896.05 851.25 978.94 23332 965.56 917.28 1,054.87 22842 896.64 851.81 979.58 23350 203.89 193.70 222.76 22843 939.79 892.80 1,026.72 # 23350 56.81 53.97 62.07 22844 1,169.67 1,111.19 1,277.87 23395 1,369.29 1,300.83 1,495.95 22845 856.18 813.37 935.38 23397 1,263.98 1,200.78 1,380.90 22846 890.00 845.50 972.33 23400 1,085.69 1,031.41 1,186.12 22847 977.85 928.96 1,068.30 23405 705.10 669.85 770.33 22848 425.73 404.44 465.11 23406 881.24 837.18 962.76 22849 1,415.65 1,344.87 1,546.60 23410 1,006.89 956.55 1,100.03 22850 774.77 736.03 846.43 23412 1,068.96 1,015.51 1,167.84 22851 474.27 450.56 518.14 23415 828.04 786.64 904.64 22852 739.99 702.99 808.44 23420 1,113.07 1,057.42 1,216.03 22855 1,172.89 1,114.25 1,281.39 23430 833.58 791.90 910.69 22900 405.66 385.38 443.19 23440 863.53 820.35 943.40 23000 595.54 565.76 650.62 23450 1,070.51 1,016.98 1,169.53 # 23000 402.55 382.42 439.78 23455 1,142.77 1,085.63 1,248.47 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 26 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 1,231.67 1,170.09 1,345.60 # 23931 182.38 173.26 199.25 23462 1,197.35 1,137.48 1,308.10 23935 553.98 526.28 605.22 23465 1,245.19 1,182.93 1,360.37 24000 517.09 491.24 564.93 23466 1,179.37 1,120.40 1,288.46 24006 782.62 743.49 855.01 23470 1,354.28 1,286.57 1,479.56 24065 238.48 226.56 260.54 23472 1,634.83 1,553.09 1,786.05 # 24065 169.63 161.15 185.32 23480 919.66 873.68 1,004.73 24066 652.39 619.77 712.74 23485 1,074.39 1,020.67 1,173.77 # 24066 426.61 405.28 466.07 23490 925.57 879.29 1,011.18 24075 518.68 492.75 566.66 23491 1,148.06 1,090.66 1,254.26 # 24075 333.19 316.53 364.01 23500 227.26 215.90 248.29 24076 508.94 483.49 556.01 # 23500 210.86 200.32 230.37 24077 885.72 841.43 967.64 23505 373.30 354.64 407.84 24100 435.72 413.93 476.02 # 23505 346.60 329.27 378.66 24101 555.76 527.97 607.17 23515 644.00 611.80 703.57 24102 684.63 650.40 747.96 23520 230.90 219.36 252.26 24105 369.23 350.77 403.39 # 23520 225.75 214.46 246.63 24110 648.37 615.95 708.34 23525 370.44 351.92 404.71 24115 776.01 737.21 847.79 # 23525 342.33 325.21 373.99 24116 962.38 914.26 1,051.40 23530 608.15 577.74 664.40 24120 578.20 549.29 631.68 23532 690.80 656.26 754.70 24125 636.59 604.76 695.47 23540 232.30 220.69 253.79 24126 696.95 662.10 761.42 # 23540 208.88 198.44 228.21 24130 565.04 536.79 617.31 23545 336.74 319.90 367.89 24134 856.13 813.32 935.32 # 23545 297.86 282.97 325.42 24136 701.73 666.64 766.64 23550 627.82 596.43 685.89 24138 728.86 692.42 796.28 23552 727.33 690.96 794.60 24140 841.59 799.51 919.44 23570 241.86 229.77 264.24 24145 720.31 684.29 786.93 # 23570 236.24 224.43 258.09 24147 745.84 708.55 814.83 23575 409.09 388.64 446.94 24149 1,185.96 1,126.66 1,295.66 # 23575 382.39 363.27 417.76 24150 1,072.44 1,018.82 1,171.64 23585 765.20 726.94 835.98 24151 1,243.92 1,181.72 1,358.98 23600 345.77 328.48 377.75 24152 809.96 769.46 884.88 # 23600 298.92 283.97 326.57 24153 740.02 703.02 808.47 23605 509.82 484.33 556.98 24155 922.69 876.56 1,008.04 # 23605 460.64 437.61 503.25 24160 677.11 643.25 739.74 23615 839.58 797.60 917.24 24164 552.19 524.58 603.27 23616 1,629.93 1,548.43 1,780.69 24200 236.40 224.58 258.27 23620 278.07 264.17 303.80 # 24200 152.55 144.92 166.66 # 23620 248.56 236.13 271.55 24201 665.25 631.99 726.79 23625 409.70 389.22 447.60 # 24201 402.93 382.78 440.20 # 23625 378.78 359.84 413.82 24220 224.73 213.49 245.51 23630 645.04 612.79 704.71 # 24220 74.84 71.10 81.77 23650 320.36 304.34 349.99 24300 438.46 416.54 479.02 # 23650 273.05 259.40 298.31 24301 843.03 800.88 921.01 23655 399.43 379.46 436.38 24305 648.36 615.94 708.33 23660 639.53 607.55 698.68 24310 530.96 504.41 580.07 23665 451.04 428.49 492.76 24320 829.22 787.76 905.92 # 23665 422.00 400.90 461.04 24330 803.69 763.51 878.04 23670 679.21 645.25 742.04 24331 888.06 843.66 970.21 23675 594.06 564.36 649.01 24332 654.07 621.37 714.58 # 23675 547.22 519.86 597.84 24340 685.84 651.55 749.28 23680 837.52 795.64 914.99 24341 730.27 693.76 797.82 23700 216.77 205.93 236.82 24342 882.28 838.17 963.90 23800 1,128.08 1,071.68 1,232.43 24343 772.96 734.31 844.46 23802 1,225.10 1,163.85 1,338.43 24344 1,174.16 1,115.45 1,282.77 23900 1,436.46 1,364.64 1,569.34 24345 767.23 728.87 838.20 23920 1,126.73 1,070.39 1,230.95 24346 1,164.65 1,106.42 1,272.38 23921 481.36 457.29 525.88 24350 499.10 474.15 545.27 23930 427.73 406.34 467.29 24351 546.31 518.99 596.84 # 23930 239.43 227.46 261.58 24352 581.76 552.67 635.57 23931 358.04 340.14 391.16 24354 581.23 552.17 635.00 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 26 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 598.01 568.11 653.33 24802 1,108.98 1,053.53 1,211.56 24360 1,001.88 951.79 1,094.56 24900 762.75 724.61 833.30 24361 1,126.76 1,070.42 1,230.98 24920 757.67 719.79 827.76 24362 1,152.31 1,094.69 1,258.89 24925 603.60 573.42 659.43 24363 1,476.27 1,402.46 1,612.83 24930 801.32 761.25 875.44 24365 717.55 681.67 783.92 24931 834.86 793.12 912.09 24366 766.45 728.13 837.35 24935 1,062.56 1,009.43 1,160.84 24400 917.98 872.08 1,002.89 25000 474.68 450.95 518.59 24410 1,157.21 1,099.35 1,264.25 25001 350.55 333.02 382.97 24420 1,099.44 1,044.47 1,201.14 25020 714.42 678.70 780.51 24430 1,038.73 986.79 1,134.81 25023 1,282.14 1,218.03 1,400.73 24435 1,108.40 1,052.98 1,210.93 25024 771.89 733.30 843.30 24470 758.15 720.24 828.28 25025 1,181.57 1,122.49 1,290.86 24495 771.26 732.70 842.61 25028 617.78 586.89 674.92 24498 975.95 927.15 1,066.22 25031 556.54 528.71 608.02 24500 371.51 352.93 405.87 25035 971.30 922.74 1,061.15 # 24500 316.71 300.87 346.00 25040 665.42 632.15 726.97 24505 544.47 517.25 594.84 25065 234.70 222.97 256.42 # 24505 487.79 463.40 532.91 # 25065 172.87 164.23 188.86 24515 969.54 921.06 1,059.22 25066 516.22 490.41 563.97 24516 956.89 909.05 1,045.41 25075 442.88 420.74 483.85 24530 401.88 381.79 439.06 25076 667.43 634.06 729.17 # 24530 347.07 329.72 379.18 25077 1,001.12 951.06 1,093.72 24535 679.65 645.67 742.52 25085 580.31 551.29 633.98 # 24535 622.50 591.38 680.09 25100 421.56 400.48 460.55 24538 837.35 795.48 914.80 25101 487.34 462.97 532.42 24545 871.65 828.07 952.28 25105 604.99 574.74 660.95 24546 1,244.39 1,182.17 1,359.50 25107 678.96 645.01 741.76 24560 335.95 319.15 367.02 25110 506.80 481.46 553.68 # 24560 275.52 261.74 301.00 25111 372.23 353.62 406.66 24565 561.66 533.58 613.62 25112 449.28 426.82 490.84 # 24565 510.61 485.08 557.84 25115 1,051.65 999.07 1,148.93 24566 735.03 698.28 803.02 25116 935.72 888.93 1,022.27 24575 878.59 834.66 959.86 25118 465.24 441.98 508.28 24576 352.14 334.53 384.71 25119 627.93 596.53 686.01 # 24576 302.95 287.80 330.97 25120 842.51 800.38 920.44 24577 586.39 557.07 640.63 25125 934.36 887.64 1,020.79 # 24577 535.33 508.56 584.84 25126 952.66 905.03 1,040.78 24579 941.82 894.73 1,028.94 25130 536.31 509.49 585.91 24582 816.29 775.48 891.80 25135 659.19 626.23 720.16 24586 1,218.12 1,157.21 1,330.79 25136 580.41 551.39 634.10 24587 1,201.98 1,141.88 1,313.16 25145 852.05 809.45 930.87 24600 411.56 390.98 449.63 25150 704.16 668.95 769.29 # 24600 347.86 330.47 380.04 25151 929.55 883.07 1,015.53 24605 496.18 471.37 542.08 25170 1,209.30 1,148.84 1,321.17 24615 793.82 754.13 867.25 25210 583.57 554.39 637.55 24620 605.51 575.23 661.51 25215 763.08 724.93 833.67 24635 1,258.51 1,195.58 1,374.92 25230 521.66 495.58 569.92 24640 138.02 131.12 150.79 25240 557.97 530.07 609.58 # 24640 88.83 84.39 97.05 25246 221.68 210.60 242.19 24650 274.82 261.08 300.24 # 25246 82.56 78.43 90.19 # 24650 226.58 215.25 247.54 25248 627.08 595.73 685.09 24655 476.98 453.13 521.10 25250 581.42 552.35 635.20 # 24655 422.17 401.06 461.22 25251 792.09 752.49 865.36 24665 722.27 686.16 789.08 25259 437.84 415.95 478.34 24666 809.00 768.55 883.83 25260 973.61 924.93 1,063.67 24670 307.34 291.97 335.77 25263 971.69 923.11 1,061.58 # 24670 258.63 245.70 282.56 25265 1,112.09 1,056.49 1,214.96 24675 495.84 471.05 541.71 25270 833.98 792.28 911.12 # 24675 447.12 424.76 488.47 25272 916.58 870.75 1,001.36 24685 752.58 714.95 822.19 25274 1,031.51 979.93 1,126.92 24800 907.83 862.44 991.81 25275 736.05 699.25 804.14 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 26 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 915.06 869.31 999.71 25565 568.62 540.19 621.22 25290 940.57 893.54 1,027.57 # 25565 508.67 483.24 555.73 25295 863.43 820.26 943.30 25574 656.24 623.43 716.94 25300 786.75 747.41 859.52 25575 921.02 874.97 1,006.22 25301 753.89 716.20 823.63 25600 310.29 294.78 339.00 25310 974.54 925.81 1,064.68 # 25600 257.83 244.94 281.68 25312 1,080.44 1,026.42 1,180.38 25605 603.03 572.88 658.81 25315 1,132.43 1,075.81 1,237.18 # 25605 555.72 527.93 607.12 25316 1,307.40 1,242.03 1,428.33 25611 773.63 734.95 845.19 25320 1,014.39 963.67 1,108.22 25620 726.99 690.64 794.24 25332 943.43 896.26 1,030.70 25622 317.58 301.70 346.96 25335 1,117.64 1,061.76 1,221.02 # 25622 262.78 249.64 287.09 25337 976.35 927.53 1,066.66 25624 500.64 475.61 546.95 25350 1,052.69 1,000.06 1,150.07 # 25624 442.55 420.42 483.48 25355 1,146.51 1,089.18 1,252.56 25628 746.71 709.37 815.78 25360 1,032.49 980.87 1,128.00 25630 325.39 309.12 355.49 25365 1,297.79 1,232.90 1,417.84 # 25630 267.31 253.94 292.03 25370 1,360.25 1,292.24 1,486.08 25635 477.56 453.68 521.73 25375 1,363.39 1,295.22 1,489.50 # 25635 381.54 362.46 416.83 25390 1,151.23 1,093.67 1,257.72 25645 638.59 606.66 697.66 25391 1,391.57 1,321.99 1,520.29 25650 338.14 321.23 369.41 25392 1,371.71 1,303.12 1,498.59 # 25650 284.74 270.50 311.08 25393 1,546.70 1,469.37 1,689.78 25651 498.37 473.45 544.47 25394 842.71 800.57 920.66 25652 669.99 636.49 731.96 25400 1,206.32 1,146.00 1,317.90 25660 428.19 406.78 467.80 25405 1,457.88 1,384.99 1,592.74 25670 684.60 650.37 747.93 25415 1,376.50 1,307.68 1,503.83 25671 559.89 531.90 611.69 25420 1,591.62 1,512.04 1,738.85 25675 470.61 447.08 514.14 25425 1,596.81 1,516.97 1,744.52 # 25675 423.30 402.14 462.46 25426 1,488.54 1,414.11 1,626.23 25676 705.99 670.69 771.29 25430 752.75 715.11 822.38 25680 485.03 460.78 529.90 25431 871.42 827.85 952.03 25685 806.99 766.64 881.64 25440 908.96 863.51 993.04 25690 505.51 480.23 552.26 25441 1,049.37 996.90 1,146.44 25695 707.18 671.82 772.59 25442 897.06 852.21 980.04 25800 866.02 822.72 946.13 25443 868.09 824.69 948.39 25805 987.84 938.45 1,079.22 25444 922.35 876.23 1,007.66 25810 938.92 891.97 1,025.77 25445 810.56 770.03 885.53 25820 704.29 669.08 769.44 25446 1,296.80 1,231.96 1,416.75 25825 847.59 805.21 925.99 25447 870.37 826.85 950.88 25830 1,126.32 1,070.00 1,230.50 25449 1,148.12 1,090.71 1,254.32 25900 989.88 940.39 1,081.45 25450 835.89 794.10 913.22 25905 985.15 935.89 1,076.27 25455 916.29 870.48 1,001.05 25907 897.29 852.43 980.29 25490 1,070.15 1,016.64 1,169.14 25909 979.39 930.42 1,069.98 25491 1,126.95 1,070.60 1,231.19 25915 1,660.76 1,577.72 1,814.38 25492 1,278.30 1,214.39 1,396.55 25920 757.19 719.33 827.23 25500 276.35 262.53 301.91 25922 662.03 628.93 723.27 # 25500 236.07 224.27 257.91 25924 758.73 720.79 828.91 25505 543.59 516.41 593.87 25927 938.87 891.93 1,025.72 # 25505 491.12 466.56 536.54 25929 614.14 583.43 670.94 25515 767.19 728.83 838.15 25931 885.43 841.16 967.33 25520 606.23 575.92 662.31 26010 328.23 311.82 358.59 # 25520 568.75 540.31 621.36 # 26010 143.21 136.05 156.46 25525 1,024.85 973.61 1,119.65 26011 511.83 486.24 559.18 25526 1,221.26 1,160.20 1,334.23 # 26011 206.89 196.55 226.03 25530 270.78 257.24 295.83 26020 460.54 437.51 503.14 # 25530 228.63 217.20 249.78 26025 456.26 433.45 498.47 25535 515.65 489.87 563.35 26030 534.11 507.40 583.51 # 25535 481.93 457.83 526.50 26034 578.63 549.70 632.16 25545 763.42 725.25 834.04 26035 794.99 755.24 868.53 25560 281.58 267.50 307.63 26037 621.53 590.45 679.02 # 25560 230.52 218.99 251.84 26040 339.83 322.84 371.27 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