1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 1 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 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 144.74 137.50 158.13 D0421 9.26 8.80 10.12 G0182 153.88 146.19 168.12 D0431 9.26 8.80 10.12 G0186 366.43 348.11 400.33 D0475 21.10 20.05 23.06 G0202 171.10 162.55 186.93 D0476 96.26 91.45 105.17 G0202 TC 131.22 124.66 143.36 D0477 71.12 67.56 77.69 G0202 26 39.88 37.89 43.57 D0478 119.49 113.52 130.55 G0204 178.52 169.59 195.03 D0479 152.30 144.69 166.39 G0204 TC 129.19 122.73 141.14 D0481 520.38 494.36 568.51 G0204 26 49.33 46.86 53.89 D0482 111.63 106.05 121.96 G0206 144.45 137.23 157.81 D0483 96.43 91.61 105.35 G0206 TC 104.57 99.34 114.24 D0484 90.47 85.95 98.84 G0206 26 39.88 37.89 43.57 # D0484 79.19 75.23 86.51 G0237 24.36 23.14 26.61 D0485 141.46 134.39 154.55 G0238 25.38 24.11 27.73 D7288 169.71 161.22 185.40 G0239 17.25 16.39 18.85 # D7288 112.34 106.72 122.73 G0245 75.62 71.84 82.62 D7321 368.24 349.83 402.30 # G0245 51.25 48.69 55.99 # D7321 286.24 271.93 312.72 G0246 45.57 43.29 49.78 D7511 303.06 287.91 331.10 # G0246 26.27 24.96 28.70 # D7511 240.29 228.28 262.52 G0247 46.51 44.18 50.81 D7521 175.42 166.65 191.65 # G0247 30.77 29.23 33.61 # D7521 111.18 105.62 121.46 G0248 336.94 320.09 368.10 G0101 44.55 42.32 48.67 G0249 201.85 191.76 220.52 # G0101 26.78 25.44 29.26 G0250 10.35 9.83 11.30 G0102 26.72 25.38 29.19 G0268 56.41 53.59 61.63 # G0102 9.96 9.46 10.88 # G0268 36.61 34.78 40.00 G0104 155.41 147.64 169.79 G0270 24.11 22.90 26.34 # G0104 65.02 61.77 71.04 G0271 9.39 8.92 10.26 G0105 464.96 441.71 507.97 G0275 15.13 14.37 16.53 # G0105 226.79 215.45 247.77 G0278 15.13 14.37 16.53 G0105 53 155.41 147.64 169.79 G0281 12.89 12.25 14.09 # G0105 53 65.02 61.77 71.04 G0283 12.89 12.25 14.09 G0106 173.03 164.38 189.04 G0288 544.77 517.53 595.16 G0106 TC 116.96 111.11 127.78 G0289 105.09 99.84 114.82 G0106 26 56.07 53.27 61.26 G0308 944.77 897.53 1,032.16 G0108 42.40 40.28 46.32 G0309 786.62 747.29 859.38 G0109 24.62 23.39 26.90 G0310 629.38 597.91 687.60 G0117 54.46 51.74 59.50 G0311 630.24 598.73 688.54 # G0117 27.55 26.17 30.10 G0312 524.84 498.60 573.39 G0118 33.83 32.14 36.96 G0313 419.96 398.96 458.80 # G0118 9.96 9.46 10.88 G0314 556.40 528.58 607.87 G0120 173.03 164.38 189.04 G0315 463.20 440.04 506.05 G0120 TC 116.96 111.11 127.78 G0316 370.52 351.99 404.79 G0120 26 56.07 53.27 61.26 G0317 349.59 332.11 381.93 G0121 464.96 441.71 507.97 G0318 291.13 276.57 318.06 # G0121 226.79 215.45 247.77 G0319 232.68 221.05 254.21 G0121 53 155.41 147.64 169.79 G0320 786.62 747.29 859.38 # G0121 53 65.02 61.77 71.04 G0321 524.84 498.60 573.39 G0124 24.58 23.35 26.85 G0322 463.20 440.04 506.05 G0127 19.61 18.63 21.42 G0323 291.13 276.57 318.06 # G0127 10.47 9.95 11.44 G0324 26.16 24.85 28.58 G0128 4.91 4.66 5.36 G0325 15.36 14.59 16.78 G0130 54.29 51.58 59.32 G0326 17.44 16.57 19.06 G0130 TC 41.86 39.77 45.74 G0327 9.80 9.31 10.71 G0130 26 12.43 11.81 13.58 G0329 9.71 9.22 10.60 G0141 24.58 23.35 26.85 # G0329 3.62 3.44 3.96 G0166 184.79 175.55 201.88 G0332 96.99 92.14 105.96 # G0166 4.52 4.29 4.93 G0341 577.63 548.75 631.06 G0168 116.91 111.06 127.72 # G0341 417.66 396.78 456.30 # G0168 29.56 28.08 32.29 G0342 773.22 734.56 844.74 G0179 70.45 66.93 76.97 G0343 1,275.29 1,211.53 1,393.26 G0180 91.01 86.46 99.43 G0344 112.41 106.79 122.81 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 2 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 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 79.40 75.43 86.74 11006 773.00 734.35 844.50 G0364 14.37 13.65 15.70 11008 314.26 298.55 343.33 # G0364 10.31 9.79 11.26 11010 530.52 503.99 579.59 G0365 219.10 208.15 239.37 # 11010 314.19 298.48 343.25 G0365 TC 204.23 194.02 223.12 11011 627.42 596.05 685.46 G0365 26 14.87 14.13 16.25 # 11011 331.36 314.79 362.01 G0366 33.31 31.64 36.39 11012 914.59 868.86 999.19 G0367 23.35 22.18 25.51 # 11012 493.60 468.92 539.26 G0368 9.96 9.46 10.88 11040 47.50 45.13 51.90 G0372 26.72 25.38 29.19 # 11040 31.76 30.17 34.70 # G0372 9.96 9.46 10.88 11041 68.15 64.74 74.45 G0375 14.23 13.52 15.55 # 11041 51.39 48.82 56.14 G0376 28.22 26.81 30.83 11042 96.40 91.58 105.32 # G0376 27.71 26.32 30.27 # 11042 69.48 66.01 75.91 M0064 32.03 30.43 34.99 11043 273.40 259.73 298.69 # M0064 20.85 19.81 22.78 # 11043 233.28 221.62 254.86 P3001 24.58 23.35 26.85 11044 357.12 339.26 390.15 Q0035 30.26 28.75 33.06 # 11044 321.58 305.50 351.33 Q0035 TC 20.30 19.29 22.18 11055 46.54 44.21 50.84 Q0035 26 9.96 9.46 10.88 # 11055 26.73 25.39 29.20 Q0091 49.03 46.58 53.57 11056 58.15 55.24 63.53 # Q0091 22.12 21.01 24.16 # 11056 37.33 35.46 40.78 Q0092 16.50 15.68 18.03 11057 71.03 67.48 77.60 R0070 174.06 165.36 190.16 # 11057 48.69 46.26 53.20 R0075 174.06 165.36 190.16 11100 95.99 91.19 104.87 0016T 366.43 348.11 400.33 # 11100 51.30 48.74 56.05 0024T 656.52 623.69 717.24 11101 33.33 31.66 36.41 0030T 26.18 24.87 28.60 # 11101 26.22 24.91 28.65 0067T 530.58 504.05 579.66 11200 84.00 79.80 91.77 0067T TC 463.00 439.85 505.83 # 11200 69.78 66.29 76.23 0067T 26 67.58 64.20 73.83 11201 19.99 18.99 21.84 0073T 920.85 874.81 1,006.03 # 11201 17.96 17.06 19.62 10021 161.97 153.87 176.95 11300 71.02 67.47 77.59 # 10021 79.70 75.72 87.08 # 11300 31.41 29.84 34.32 10022 181.28 172.22 198.05 11301 90.70 86.17 99.10 # 10022 73.12 69.46 79.88 # 11301 53.62 50.94 58.58 10040 98.81 93.87 107.95 11302 108.44 103.02 118.47 # 10040 87.64 83.26 95.75 # 11302 65.78 62.49 71.86 10060 110.30 104.79 120.51 11303 130.60 124.07 142.68 # 10060 96.08 91.28 104.97 # 11303 76.77 72.93 83.87 10061 193.48 183.81 211.38 11305 71.17 67.61 77.75 # 10061 176.73 167.89 193.07 # 11305 41.72 39.63 45.57 10080 206.54 196.21 225.64 11306 96.42 91.60 105.34 # 10080 104.97 99.72 114.68 # 11306 61.89 58.80 67.62 10081 309.21 293.75 337.81 11307 111.95 106.35 122.30 # 10081 178.19 169.28 194.67 # 11307 71.33 67.76 77.92 10120 161.52 153.44 176.46 11308 132.15 125.54 144.37 # 10120 100.07 95.07 109.33 # 11308 88.47 84.05 96.66 10121 292.41 277.79 319.46 11310 85.99 81.69 93.94 # 10121 204.55 194.32 223.47 # 11310 45.87 43.58 50.12 10140 155.09 147.34 169.44 11311 104.88 99.64 114.59 # 10140 130.21 123.70 142.26 # 11311 67.30 63.94 73.53 10160 131.77 125.18 143.96 11312 120.66 114.63 131.82 # 10160 105.37 100.10 115.12 # 11312 76.48 72.66 83.56 10180 248.73 236.29 271.73 11313 157.93 150.03 172.53 # 10180 197.95 188.05 216.26 # 11313 102.57 97.44 112.06 11000 54.72 51.98 59.78 11400 136.39 129.57 149.01 # 11000 36.43 34.61 39.80 # 11400 79.51 75.53 86.86 11001 24.43 23.21 26.69 11401 155.32 147.55 169.68 # 11001 18.34 17.42 20.03 # 11401 102.51 97.38 111.99 11004 619.49 588.52 676.80 11402 175.68 166.90 191.94 11005 846.38 804.06 924.67 # 11402 117.28 111.42 128.13 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 31140 PAGE 3 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 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 196.28 186.47 214.44 11624 317.12 301.26 346.45 # 11403 141.44 134.37 154.53 # 11624 217.08 206.23 237.16 11404 223.60 212.42 244.28 11626 415.00 394.25 453.39 # 11404 157.08 149.23 171.61 # 11626 301.25 286.19 329.12 11406 272.06 258.46 297.23 11640 190.75 181.21 208.39 # 11406 199.94 189.94 218.43 # 11640 112.03 106.43 122.39 11420 130.55 124.02 142.62 11641 242.54 230.41 264.97 # 11420 87.89 83.50 96.03 # 11641 166.37 158.05 181.76 11421 164.03 155.83 179.20 11642 279.45 265.48 305.30 # 11421 115.27 109.51 125.94 # 11642 193.12 183.46 210.98 11422 182.65 173.52 199.55 11643 321.49 305.42 351.23 # 11422 135.42 128.65 147.95 # 11643 228.05 216.65 249.15 11423 215.30 204.54 235.22 11644 404.98 384.73 442.44 # 11423 157.41 149.54 171.97 # 11644 291.73 277.14 318.71 11424 244.18 231.97 266.77 11646 541.06 514.01 591.11 # 11424 182.73 173.59 199.63 # 11646 424.76 403.52 464.05 11426 335.96 319.16 367.03 11719 19.86 18.87 21.70 # 11426 265.88 252.59 290.48 # 11719 10.72 10.18 11.71 11440 155.78 147.99 170.19 11720 30.80 29.26 33.65 # 11440 110.08 104.58 120.27 # 11720 19.63 18.65 21.45 11441 180.09 171.09 196.75 11721 45.25 42.99 49.44 # 11441 136.92 130.07 149.58 # 11721 33.57 31.89 36.67 11442 200.91 190.86 219.49 11730 100.08 95.08 109.34 # 11442 151.14 143.58 165.12 # 11730 69.61 66.13 76.05 11443 243.54 231.36 266.06 11732 46.43 44.11 50.73 # 11443 187.67 178.29 205.03 # 11732 35.26 33.50 38.53 11444 307.29 291.93 335.72 11740 43.43 41.26 47.45 # 11444 241.78 229.69 264.14 # 11740 33.27 31.61 36.35 11446 392.00 372.40 428.26 11750 188.58 179.15 206.02 # 11446 327.51 311.13 357.80 # 11750 167.76 159.37 183.28 11450 371.41 352.84 405.77 11752 265.71 252.42 290.28 # 11450 218.56 207.63 238.77 11755 134.57 127.84 147.02 11451 503.80 478.61 550.40 # 11755 93.94 89.24 102.63 # 11451 297.11 282.25 324.59 11760 200.71 190.67 219.27 11462 366.35 348.03 400.23 # 11760 158.06 150.16 172.68 # 11462 208.93 198.48 228.25 11762 269.00 255.55 293.88 11463 515.22 489.46 562.88 # 11762 241.58 229.50 263.93 # 11463 304.47 289.25 332.64 11765 119.94 113.94 131.03 11470 394.81 375.07 431.33 # 11765 67.63 64.25 73.89 # 11470 252.62 239.99 275.99 11770 287.75 273.36 314.36 11471 528.15 501.74 577.00 # 11770 186.69 177.36 203.96 # 11471 327.56 311.18 357.86 11771 530.44 503.92 579.51 11600 187.92 178.52 205.30 # 11771 411.61 391.03 449.68 # 11600 103.11 97.95 112.64 11772 677.23 643.37 739.88 11601 211.18 200.62 230.71 # 11772 553.32 525.65 604.50 # 11601 135.52 128.74 148.05 11900 53.90 51.21 58.89 11602 223.16 212.00 243.80 # 11900 31.55 29.97 34.47 # 11602 143.43 136.26 156.70 11901 65.64 62.36 71.71 11603 246.26 233.95 269.04 # 11901 49.89 47.40 54.51 # 11603 157.39 149.52 171.95 11920 257.48 244.61 281.30 11604 270.72 257.18 295.76 # 11920 124.42 118.20 135.93 # 11604 169.66 161.18 185.36 11921 284.46 270.24 310.78 11606 349.71 332.22 382.05 # 11921 147.35 139.98 160.98 # 11606 231.39 219.82 252.79 11922 78.84 74.90 86.14 11620 180.93 171.88 197.66 # 11922 33.64 31.96 36.75 # 11620 97.14 92.28 106.12 11950 92.32 87.70 100.86 11621 209.62 199.14 229.01 # 11950 54.23 51.52 59.25 # 11621 134.97 128.22 147.45 11951 125.06 118.81 136.63 11622 236.26 224.45 258.12 # 11951 75.29 71.53 82.26 # 11622 156.02 148.22 170.45 11952 164.69 156.46 179.93 11623 276.92 263.07 302.53 # 11952 104.77 99.53 114.46 # 11623 187.55 178.17 204.90 11954 203.15 192.99 221.94 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 4 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 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 124.44 118.22 135.95 # 12045 268.79 255.35 293.65 11960 917.24 871.38 1,002.09 12046 510.73 485.19 557.97 11970 614.75 584.01 671.61 # 12046 319.79 303.80 349.37 11971 555.60 527.82 606.99 12047 519.29 493.33 567.33 # 11971 284.42 270.20 310.73 # 12047 353.23 335.57 385.91 11976 162.35 154.23 177.36 12051 268.38 254.96 293.20 # 11976 109.53 104.05 119.66 # 12051 175.45 166.68 191.68 11980 116.10 110.30 126.85 12052 276.87 263.03 302.48 # 11980 88.68 84.25 96.89 # 12052 185.46 176.19 202.62 11981 147.34 139.97 160.97 12053 293.10 278.45 320.22 # 11981 95.54 90.76 104.37 # 12053 205.75 195.46 224.78 11982 173.04 164.39 189.05 12054 324.02 307.82 353.99 # 11982 116.16 110.35 126.90 # 12054 225.50 214.23 246.36 11983 251.41 238.84 274.67 12055 412.49 391.87 450.65 # 11983 209.76 199.27 229.16 # 12055 292.64 278.01 319.71 12001 171.44 162.87 187.30 12056 563.50 535.33 615.63 # 12001 109.48 104.01 119.61 # 12056 375.09 356.34 409.79 12002 181.26 172.20 198.03 12057 559.51 531.53 611.26 # 12002 122.85 116.71 134.22 # 12057 438.14 416.23 478.66 12004 211.37 200.80 230.92 13100 334.97 318.22 365.95 # 12004 144.33 137.11 157.68 # 13100 246.10 233.80 268.87 12005 262.56 249.43 286.84 13101 396.94 377.09 433.65 # 12005 179.78 170.79 196.41 # 13101 296.39 281.57 323.81 12006 324.86 308.62 354.91 13102 111.26 105.70 121.56 # 12006 228.88 217.44 250.06 # 13102 80.79 76.75 88.26 12007 366.81 348.47 400.74 13120 346.60 329.27 378.66 # 12007 264.74 251.50 289.23 # 13120 255.19 242.43 278.79 12011 181.66 172.58 198.47 13121 422.42 401.30 461.50 # 12011 112.59 106.96 123.00 # 13121 317.81 301.92 347.21 12013 198.28 188.37 216.63 13122 136.86 130.02 149.52 # 12013 129.72 123.23 141.71 # 13122 92.18 87.57 100.71 12014 233.18 221.52 254.75 13131 376.60 357.77 411.44 # 12014 155.99 148.19 170.42 # 13131 291.29 276.73 318.24 12015 291.74 277.15 318.72 13132 541.52 514.44 591.61 # 12015 195.76 185.97 213.87 # 13132 452.65 430.02 494.52 12016 343.67 326.49 375.46 13133 174.64 165.91 190.80 # 12016 240.08 228.08 262.29 # 13133 142.65 135.52 155.85 12017 292.43 277.81 319.48 13150 405.26 385.00 442.75 12018 347.07 329.72 379.18 # 13150 298.11 283.20 325.68 12020 304.67 289.44 332.86 13151 426.07 404.77 465.49 # 12020 208.18 197.77 227.44 # 13151 341.77 324.68 373.38 12021 171.03 162.48 186.85 13152 565.00 536.75 617.26 # 12021 149.70 142.22 163.55 # 13152 463.43 440.26 506.30 12031 204.82 194.58 223.77 13153 197.79 187.90 216.09 # 12031 137.28 130.42 149.98 # 13153 157.17 149.31 171.71 12032 296.34 281.52 323.75 13160 812.90 772.26 888.10 # 12032 192.24 182.63 210.02 14000 644.85 612.61 704.50 12034 283.21 269.05 309.41 # 14000 523.48 497.31 571.91 # 12034 194.34 184.62 212.31 14001 831.45 789.88 908.36 12035 408.35 387.93 446.12 # 14001 712.11 676.50 777.98 # 12035 253.46 240.79 276.91 14020 712.14 676.53 778.01 12036 454.89 432.15 496.97 # 14020 606.51 576.18 662.61 # 12036 301.53 286.45 329.42 14021 922.13 876.02 1,007.42 12037 509.35 483.88 556.46 # 14021 835.29 793.53 912.56 # 12037 349.89 332.40 382.26 14040 772.01 733.41 843.42 12041 227.14 215.78 248.15 # 14040 690.25 655.74 754.10 # 12041 155.03 147.28 169.37 14041 1,007.22 956.86 1,100.39 12042 277.73 263.84 303.42 # 14041 909.72 864.23 993.86 # 12042 185.81 176.52 203.00 14060 797.18 757.32 870.92 12044 293.34 278.67 320.47 # 14060 728.12 691.71 795.47 # 12044 211.08 200.53 230.61 14061 1,090.63 1,036.10 1,191.52 12045 420.63 399.60 459.54 # 14061 983.99 934.79 1,075.01 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 31140 PAGE 5 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 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 1,055.84 1,003.05 1,153.51 # 15221 79.06 75.11 86.38 # 14300 956.31 908.49 1,044.76 15240 896.40 851.58 979.32 14350 773.21 734.55 844.73 # 15240 781.63 742.55 853.93 15000 362.80 344.66 396.36 15241 203.05 192.90 221.84 # 15000 281.04 266.99 307.04 # 15241 124.84 118.60 136.39 15001 111.23 105.67 121.52 15260 930.85 884.31 1,016.96 # 15001 63.50 60.33 69.38 # 15260 847.56 805.18 925.96 15040 316.45 300.63 345.72 15261 229.76 218.27 251.01 # 15040 141.75 134.66 154.86 # 15261 163.75 155.56 178.89 15050 534.26 507.55 583.68 15300 331.60 315.02 362.27 # 15050 442.34 420.22 483.25 # 15300 282.35 268.23 308.46 15100 1,027.04 975.69 1,122.04 15301 66.55 63.22 72.70 # 15100 784.30 745.09 856.85 # 15301 62.99 59.84 68.82 15101 263.31 250.14 287.66 15320 383.00 363.85 418.43 # 15101 132.80 126.16 145.08 # 15320 327.65 311.27 357.96 15110 948.32 900.90 1,036.04 15321 99.06 94.11 108.23 # 15110 761.44 723.37 831.88 # 15321 93.98 89.28 102.67 15111 144.49 137.27 157.86 15330 331.10 314.55 361.73 # 15111 119.10 113.15 130.12 # 15330 281.84 267.75 307.91 15115 882.90 838.76 964.57 15331 66.04 62.74 72.15 # 15115 787.43 748.06 860.27 # 15331 62.99 59.84 68.82 15116 186.44 177.12 203.69 15335 366.80 348.46 400.73 # 15116 163.08 154.93 178.17 # 15335 314.49 298.77 343.59 15120 959.71 911.72 1,048.48 15336 96.06 91.26 104.95 # 15120 809.90 769.41 884.82 # 15336 89.97 85.47 98.29 15121 342.64 325.51 374.34 15340 359.67 341.69 392.94 # 15121 207.56 197.18 226.76 # 15340 296.19 281.38 323.59 15130 800.74 760.70 874.81 15341 52.07 49.47 56.89 # 15130 621.48 590.41 678.97 # 15341 31.25 29.69 34.14 15131 118.35 112.43 129.29 15360 389.91 370.41 425.97 # 15131 96.52 91.69 105.44 # 15360 319.32 303.35 348.85 15135 944.94 897.69 1,032.34 15361 78.02 74.12 85.24 # 15135 856.08 813.28 935.27 # 15361 71.92 68.32 78.57 15136 108.97 103.52 119.05 15365 405.70 385.42 443.23 # 15136 97.79 92.90 106.84 # 15365 336.63 319.80 367.77 15150 782.36 743.24 854.73 15366 96.62 91.79 105.56 # 15150 679.78 645.79 742.66 # 15366 90.52 85.99 98.89 15151 151.88 144.29 165.93 15400 372.25 353.64 406.69 # 15151 128.52 122.09 140.40 15401 139.16 132.20 152.03 15152 185.92 176.62 203.11 # 15401 65.02 61.77 71.04 # 15152 160.52 152.49 175.36 15420 432.59 410.96 472.60 15155 777.06 738.21 848.94 # 15420 382.31 363.19 417.67 # 15155 733.38 696.71 801.22 15421 131.05 124.50 143.18 15156 195.97 186.17 214.10 # 15421 95.50 90.73 104.34 # 15156 179.72 170.73 196.34 15430 593.24 563.58 648.12 15157 217.69 206.81 237.83 # 15430 578.51 549.58 632.02 # 15157 195.85 186.06 213.97 15570 969.29 920.83 1,058.95 15170 404.69 384.46 442.13 # 15570 738.23 701.32 806.52 # 15170 330.04 313.54 360.57 15572 876.27 832.46 957.33 15171 100.02 95.02 109.27 # 15572 721.38 685.31 788.11 # 15171 96.97 92.12 105.94 15574 960.63 912.60 1,049.49 15175 571.06 542.51 623.89 # 15574 813.36 772.69 888.59 # 15175 498.44 473.52 544.55 15576 858.58 815.65 938.00 15176 159.62 151.64 174.39 # 15576 712.33 676.71 778.22 # 15176 153.53 145.85 167.73 15600 468.54 445.11 511.88 15200 817.63 776.75 893.26 # 15600 237.48 225.61 259.45 # 15200 654.62 621.89 715.17 15610 342.24 325.13 373.90 15201 186.97 177.62 204.26 # 15610 277.74 263.85 303.43 # 15201 87.95 83.55 96.08 15620 520.06 494.06 568.17 15220 796.73 756.89 870.42 # 15620 321.50 305.43 351.24 # 15220 669.27 635.81 731.18 15630 495.18 470.42 540.98 15221 168.95 160.50 184.58 # 15630 347.91 330.51 380.09 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 6 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 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 529.29 502.83 578.25 # 15839 723.14 686.98 790.03 # 15650 379.99 360.99 415.14 15840 1,059.72 1,006.73 1,157.74 15732 1,666.33 1,583.01 1,820.46 15841 1,737.10 1,650.25 1,897.79 # 15732 1,369.76 1,301.27 1,496.46 15842 2,775.20 2,636.44 3,031.91 15734 1,683.22 1,599.06 1,838.92 15845 986.05 936.75 1,077.26 # 15734 1,391.22 1,321.66 1,519.91 15851 120.53 114.50 131.68 15736 1,626.14 1,544.83 1,776.55 # 15851 50.96 48.41 55.67 # 15736 1,269.14 1,205.68 1,386.53 15852 129.90 123.41 141.92 15738 1,682.20 1,598.09 1,837.80 # 15852 52.71 50.07 57.58 # 15738 1,363.79 1,295.60 1,489.94 15860 125.30 119.04 136.90 15740 932.76 886.12 1,019.04 # 15860 122.76 116.62 134.11 # 15740 837.28 795.42 914.73 15920 619.96 588.96 677.30 15750 942.39 895.27 1,029.56 15922 790.12 750.61 863.20 15756 2,540.77 2,413.73 2,775.79 15931 682.34 648.22 745.45 15757 2,575.31 2,446.54 2,813.52 15933 861.95 818.85 941.68 15758 2,577.59 2,448.71 2,816.02 15934 950.19 902.68 1,038.08 15760 873.76 830.07 954.58 15935 1,147.87 1,090.48 1,254.05 # 15760 733.09 696.44 800.91 15936 946.68 899.35 1,034.25 15770 660.72 627.68 721.83 15937 1,107.62 1,052.24 1,210.08 15775 383.08 363.93 418.52 15940 712.62 676.99 778.54 # 15775 233.78 222.09 255.40 15941 969.92 921.42 1,059.63 15776 507.37 482.00 554.30 15944 927.18 880.82 1,012.94 # 15776 377.37 358.50 412.28 15945 1,033.43 981.76 1,129.02 15780 888.62 844.19 970.82 15946 1,654.62 1,571.89 1,807.67 # 15780 722.05 685.95 788.84 15950 596.76 566.92 651.96 15781 550.16 522.65 601.05 15951 856.62 813.79 935.86 # 15781 471.44 447.87 515.05 15952 880.03 836.03 961.43 15782 679.18 645.22 742.00 15953 996.83 946.99 1,089.04 # 15782 511.09 485.54 558.37 15956 1,210.95 1,150.40 1,322.96 15783 524.68 498.45 573.22 15958 1,224.08 1,162.88 1,337.31 # 15783 387.57 368.19 423.42 16000 80.56 76.53 88.01 15786 252.97 240.32 276.37 # 16000 50.09 47.59 54.73 # 15786 149.37 141.90 163.19 16020 98.86 93.92 108.01 15787 69.28 65.82 75.69 # 16020 62.81 59.67 68.62 # 15787 22.06 20.96 24.10 16025 167.14 158.78 182.60 15788 426.46 405.14 465.91 # 16025 126.00 119.70 137.66 # 15788 241.61 229.53 263.96 16030 198.21 188.30 216.55 15789 609.37 578.90 665.74 # 16030 144.38 137.16 157.73 # 15789 441.79 419.70 482.66 16035 238.28 226.37 260.33 15792 437.23 415.37 477.68 16036 94.24 89.53 102.96 # 15792 302.65 287.52 330.65 17000 73.53 69.85 80.33 15793 470.92 447.37 514.48 # 17000 51.70 49.12 56.49 # 15793 373.93 355.23 408.51 17003 11.72 11.13 12.80 15819 757.09 719.24 827.13 # 17003 9.69 9.21 10.59 15820 566.45 538.13 618.85 17004 229.46 217.99 250.69 # 15820 494.85 470.11 540.63 # 17004 192.89 183.25 210.74 15821 609.34 578.87 665.70 17106 422.39 401.27 461.46 # 15821 526.06 499.76 574.72 # 17106 357.89 340.00 391.00 15822 480.36 456.34 524.79 17107 741.09 704.04 809.65 # 15822 411.80 391.21 449.89 # 17107 652.22 619.61 712.55 15823 688.13 653.72 751.78 17108 1,002.06 951.96 1,094.75 # 15823 616.02 585.22 673.00 # 17108 920.30 874.29 1,005.43 15831 944.17 896.96 1,031.50 17110 109.00 103.55 119.08 15832 919.32 873.35 1,004.35 # 17110 62.28 59.17 68.05 15833 871.26 827.70 951.86 17111 122.13 116.02 133.42 15834 856.05 813.25 935.24 # 17111 78.45 74.53 85.71 15835 880.35 836.33 961.78 17250 83.05 78.90 90.74 15836 744.34 707.12 813.19 # 17250 38.36 36.44 41.91 15837 794.58 754.85 868.08 17260 101.68 96.60 111.09 # 15837 734.66 697.93 802.62 # 17260 70.70 67.17 77.25 15838 602.34 572.22 658.05 17261 128.89 122.45 140.82 15839 847.05 804.70 925.41 # 17261 89.28 84.82 97.54 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 7 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 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 159.43 151.46 174.18 19110 477.38 453.51 521.54 # 17262 115.25 109.49 125.91 # 19110 328.08 311.68 358.43 17263 176.55 167.72 192.88 19112 464.16 440.95 507.09 # 17263 127.29 120.93 139.07 # 19112 292.01 277.41 319.02 17264 191.31 181.74 209.00 19120 466.76 443.42 509.93 # 17264 134.94 128.19 147.42 # 19120 391.61 372.03 427.83 17266 221.47 210.40 241.96 19125 500.29 475.28 546.57 # 17266 155.96 148.16 170.38 # 19125 424.12 402.91 463.35 17270 139.34 132.37 152.23 19126 175.08 166.33 191.28 # 17270 97.19 92.33 106.18 19140 581.85 552.76 635.67 17271 150.32 142.80 164.22 # 19140 390.90 371.36 427.06 # 17271 109.69 104.21 119.84 19160 428.23 406.82 467.84 17272 172.72 164.08 188.69 19162 896.55 851.72 979.48 # 17272 127.52 121.14 139.31 19180 629.33 597.86 687.54 17273 194.61 184.88 212.61 19182 570.19 541.68 622.93 # 17273 143.83 136.64 157.14 19200 1,059.41 1,006.44 1,157.41 17274 234.57 222.84 256.27 19220 1,085.84 1,031.55 1,186.28 # 17274 177.18 168.32 193.57 19240 1,096.53 1,041.70 1,197.96 17276 279.27 265.31 305.11 19260 1,225.13 1,163.87 1,338.45 # 17276 214.78 204.04 234.65 19271 1,718.88 1,632.94 1,877.88 17280 128.89 122.45 140.82 19272 1,881.72 1,787.63 2,055.77 # 17280 88.26 83.85 96.43 19290 196.78 186.94 214.98 17281 166.19 157.88 181.56 # 19290 72.87 69.23 79.61 # 17281 124.55 118.32 136.07 19291 87.14 82.78 95.20 17282 191.68 182.10 209.42 # 19291 36.36 34.54 39.72 # 17282 144.96 137.71 158.37 19295 137.36 130.49 150.06 17283 235.76 223.97 257.57 19296 6,537.18 6,210.32 7,141.87 # 17283 181.93 172.83 198.75 # 19296 228.96 217.51 250.14 17284 277.91 264.01 303.61 19297 104.16 98.95 113.79 # 17284 218.49 207.57 238.71 19298 2,393.04 2,273.39 2,614.40 17286 366.32 348.00 400.20 # 19298 368.85 350.41 402.97 # 17286 303.85 288.66 331.96 19316 841.37 799.30 919.20 17304 724.58 688.35 791.60 19318 1,252.70 1,190.07 1,368.58 # 17304 486.40 462.08 531.39 19324 498.63 473.70 544.76 17305 312.55 296.92 341.46 19325 695.98 661.18 760.36 # 17305 182.55 173.42 199.43 19328 500.29 475.28 546.57 17306 313.57 297.89 342.57 19330 635.64 603.86 694.44 # 17306 183.06 173.91 200.00 19340 432.49 410.87 472.50 17307 295.80 281.01 323.16 19342 938.18 891.27 1,024.96 # 17307 183.57 174.39 200.55 19350 1,089.13 1,034.67 1,189.87 17310 120.27 114.26 131.40 # 19350 749.40 711.93 818.72 # 17310 61.36 58.29 67.03 19355 841.28 799.22 919.10 17340 49.83 47.34 54.44 # 19355 558.42 530.50 610.08 # 17340 49.33 46.86 53.89 19357 1,578.67 1,499.74 1,724.70 17360 130.70 124.17 142.80 19361 1,459.58 1,386.60 1,594.59 # 17360 101.75 96.66 111.16 19364 2,958.26 2,810.35 3,231.90 19000 135.98 129.18 148.56 19366 1,503.03 1,427.88 1,642.06 # 19000 50.66 48.13 55.35 19367 1,957.19 1,859.33 2,138.23 19001 30.16 28.65 32.95 19368 2,369.21 2,250.75 2,588.36 # 19001 24.57 23.34 26.84 19369 2,216.05 2,105.25 2,421.04 19020 473.21 449.55 516.98 19370 698.60 663.67 763.22 # 19020 286.84 272.50 313.38 19371 804.45 764.23 878.86 19030 207.98 197.58 227.22 19380 785.68 746.40 858.36 # 19030 87.62 83.24 95.73 19396 147.36 139.99 160.99 19100 159.90 151.91 174.70 # 19396 142.79 135.65 156.00 # 19100 75.09 71.34 82.04 20000 226.44 215.12 247.39 19101 363.38 345.21 396.99 # 20000 177.68 168.80 194.12 # 19101 231.86 220.27 253.31 20005 322.84 306.70 352.71 19102 276.91 263.06 302.52 # 20005 259.87 246.88 283.91 # 19102 115.42 109.65 126.10 20100 651.44 618.87 711.70 19103 737.15 700.29 805.33 20101 438.81 416.87 479.40 # 19103 214.60 203.87 234.45 # 20101 219.42 208.45 239.72 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 8 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 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 546.09 518.79 596.61 20692 468.90 445.46 512.28 # 20102 263.23 250.07 287.58 20693 530.91 504.36 580.01 20103 662.73 629.59 724.03 20694 543.90 516.71 594.22 # 20103 398.66 378.73 435.54 # 20694 385.97 366.67 421.67 20150 944.29 897.08 1,031.64 20802 2,772.65 2,634.02 3,029.12 20200 217.32 206.45 237.42 20805 3,825.29 3,634.03 4,179.13 # 20200 101.03 95.98 110.38 20808 4,734.01 4,497.31 5,171.91 20205 298.37 283.45 325.97 20816 3,247.80 3,085.41 3,548.22 # 20205 160.75 152.71 175.62 20822 2,866.95 2,723.60 3,132.14 20206 371.66 353.08 406.04 20824 3,186.55 3,027.22 3,481.30 # 20206 72.55 68.92 79.26 20827 2,982.26 2,833.15 3,258.12 20220 283.86 269.67 310.12 20838 2,784.03 2,644.83 3,041.55 # 20220 91.91 87.31 100.41 20900 670.78 637.24 732.83 20225 1,323.97 1,257.77 1,446.44 # 20900 530.62 504.09 579.70 # 20225 136.16 129.35 148.75 20902 678.22 644.31 740.96 20240 267.55 254.17 292.30 20910 490.65 466.12 536.04 20245 671.75 638.16 733.88 20912 560.75 532.71 612.62 20250 400.32 380.30 437.35 20920 438.98 417.03 479.58 20251 457.83 434.94 500.18 20922 660.06 627.06 721.12 20500 166.48 158.16 181.88 # 20922 523.97 497.77 572.44 # 20500 128.90 122.46 140.83 20924 579.05 550.10 632.62 20501 179.08 170.13 195.65 20926 479.71 455.72 524.08 # 20501 43.49 41.32 47.52 20931 128.83 122.39 140.75 20520 226.03 214.73 246.94 20937 196.39 186.57 214.56 # 20520 167.63 159.25 183.14 20938 213.47 202.80 233.22 20525 615.15 584.39 672.05 20950 402.73 382.59 439.98 # 20525 283.03 268.88 309.21 # 20950 104.63 99.40 114.31 20526 89.34 84.87 97.60 20955 2,892.31 2,747.69 3,159.84 # 20526 66.48 63.16 72.63 20956 2,970.83 2,822.29 3,245.63 20550 67.69 64.31 73.96 20957 2,730.39 2,593.87 2,982.95 # 20550 43.32 41.15 47.32 20962 3,050.38 2,897.86 3,332.54 20551 65.92 62.62 72.01 20969 3,194.55 3,034.82 3,490.04 # 20551 48.15 45.74 52.60 20970 3,141.88 2,984.79 3,432.51 20552 63.68 60.50 69.58 20972 2,862.79 2,719.65 3,127.60 # 20552 37.28 35.42 40.73 20973 3,210.07 3,049.57 3,507.01 20553 72.05 68.45 78.72 20974 62.07 58.97 67.82 # 20553 41.58 39.50 45.43 # 20974 54.46 51.74 59.50 20600 60.87 57.83 66.50 20975 201.40 191.33 220.03 # 20600 45.64 43.36 49.86 20979 67.17 63.81 73.38 20605 67.24 63.88 73.46 # 20979 43.81 41.62 47.86 # 20605 46.93 44.58 51.27 20982 5,881.16 5,587.10 6,425.17 20610 81.94 77.84 89.52 # 20982 453.51 430.83 495.45 # 20610 55.03 52.28 60.12 21010 785.40 746.13 858.05 20612 65.98 62.68 72.08 21015 479.30 455.34 523.64 # 20612 48.21 45.80 52.67 21025 1,049.99 997.49 1,147.11 20615 273.12 259.46 298.38 # 21025 902.72 857.58 986.22 # 20615 188.31 178.89 205.72 21026 604.81 574.57 660.76 20650 215.47 204.70 235.41 # 21026 526.61 500.28 575.32 # 20650 173.83 165.14 189.91 21029 802.57 762.44 876.81 20660 268.40 254.98 293.23 # 21029 682.22 648.11 745.33 # 20660 194.77 185.03 212.78 21030 511.91 486.31 559.26 20661 469.39 445.92 512.81 # 21030 445.38 423.11 486.58 20662 532.85 506.21 582.14 21031 401.98 381.88 439.16 20663 481.57 457.49 526.11 # 21031 323.27 307.11 353.18 20664 717.21 681.35 783.55 21032 410.88 390.34 448.89 20665 165.76 157.47 181.09 # 21032 317.44 301.57 346.81 # 20665 124.63 118.40 136.16 21034 1,486.65 1,412.32 1,624.17 20670 662.71 629.57 724.01 # 21034 1,320.59 1,254.56 1,442.74 # 20670 182.31 173.19 199.17 21040 514.95 489.20 562.58 20680 592.22 562.61 647.00 # 21040 429.64 408.16 469.38 # 20680 334.24 317.53 365.16 21044 969.40 920.93 1,059.07 20690 280.20 266.19 306.12 21045 1,300.16 1,235.15 1,420.42 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 9 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 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 1,160.61 1,102.58 1,267.97 21175 2,324.22 2,208.01 2,539.21 21047 1,471.12 1,397.56 1,607.19 21179 1,660.23 1,577.22 1,813.80 21048 1,190.18 1,130.67 1,300.27 21180 1,855.41 1,762.64 2,027.04 21049 1,407.30 1,336.94 1,537.48 21181 800.34 760.32 874.37 21050 938.84 891.90 1,025.69 21182 2,303.24 2,188.08 2,516.29 21060 872.78 829.14 953.51 21183 2,554.17 2,426.46 2,790.43 21070 714.15 678.44 780.21 21184 2,755.41 2,617.64 3,010.29 21076 1,203.89 1,143.70 1,315.26 21188 1,882.29 1,788.18 2,056.41 # 21076 1,084.05 1,029.85 1,184.33 21193 1,370.96 1,302.41 1,497.77 21077 3,029.69 2,878.21 3,309.94 21194 1,527.15 1,450.79 1,668.41 # 21077 2,758.51 2,620.58 3,013.67 21195 1,470.13 1,396.62 1,606.11 21079 2,047.67 1,945.29 2,237.08 21196 1,590.94 1,511.39 1,738.10 # 21079 1,826.26 1,734.95 1,995.19 21198 1,237.12 1,175.26 1,351.55 21080 2,322.44 2,206.32 2,537.27 21199 1,125.24 1,068.98 1,229.33 # 21080 2,061.42 1,958.35 2,252.10 21206 1,228.50 1,167.08 1,342.14 21081 2,110.71 2,005.17 2,305.95 21208 1,564.39 1,486.17 1,709.10 # 21081 1,865.94 1,772.64 2,038.54 # 21208 915.39 869.62 1,000.06 21082 1,879.34 1,785.37 2,053.18 21209 835.37 793.60 912.64 # 21082 1,695.50 1,610.73 1,852.34 # 21209 696.23 661.42 760.63 21083 1,783.64 1,694.46 1,948.63 21210 1,699.07 1,614.12 1,856.24 # 21083 1,561.72 1,483.63 1,706.17 # 21210 908.89 863.45 992.97 21084 2,078.15 1,974.24 2,270.38 21215 2,592.28 2,462.67 2,832.07 # 21084 1,836.93 1,745.08 2,006.84 # 21215 936.25 889.44 1,022.86 21085 805.96 765.66 880.51 21230 862.79 819.65 942.60 # 21085 729.28 692.82 796.74 21235 779.47 740.50 851.58 21086 2,276.56 2,162.73 2,487.14 # 21235 604.77 574.53 660.71 # 21086 2,057.18 1,954.32 2,247.47 21240 1,219.03 1,158.08 1,331.79 21087 2,246.53 2,134.20 2,454.33 21242 1,137.11 1,080.25 1,242.29 # 21087 2,038.33 1,936.41 2,226.87 21243 1,782.15 1,693.04 1,947.00 21088 2,781.77 2,642.68 3,039.08 21244 1,111.24 1,055.68 1,214.03 21100 760.57 722.54 830.92 21245 1,227.07 1,165.72 1,340.58 # 21100 414.74 394.00 453.10 # 21245 995.50 945.73 1,087.59 21110 708.73 673.29 774.28 21246 982.24 933.13 1,073.10 # 21110 647.29 614.93 707.17 21247 1,839.90 1,747.91 2,010.10 21116 253.65 240.97 277.12 21248 1,105.77 1,050.48 1,208.05 # 21116 50.01 47.51 54.64 # 21248 966.63 918.30 1,056.05 21120 746.59 709.26 815.65 21249 1,598.84 1,518.90 1,746.74 # 21120 589.16 559.70 643.66 # 21249 1,393.67 1,323.99 1,522.59 21121 817.12 776.26 892.70 21255 1,535.03 1,458.28 1,677.02 # 21121 719.62 683.64 786.19 21256 1,273.03 1,209.38 1,390.79 21122 798.96 759.01 872.86 21260 1,321.14 1,255.08 1,443.34 21123 1,021.47 970.40 1,115.96 21261 2,551.59 2,424.01 2,787.61 21125 3,247.61 3,085.23 3,548.01 21263 2,149.29 2,041.83 2,348.10 # 21125 858.79 815.85 938.23 21267 1,789.12 1,699.66 1,954.61 21127 2,652.48 2,519.86 2,897.84 21268 2,078.05 1,974.15 2,270.27 # 21127 954.31 906.59 1,042.58 21270 1,011.38 960.81 1,104.93 21137 810.92 770.37 885.93 # 21270 787.43 748.06 860.27 21138 1,005.77 955.48 1,098.80 21275 887.32 842.95 969.39 21139 1,164.57 1,106.34 1,272.29 21280 548.14 520.73 598.84 21141 1,461.97 1,388.87 1,597.20 21282 370.93 352.38 405.24 21142 1,448.41 1,375.99 1,582.39 21295 192.95 183.30 210.80 21143 1,536.51 1,459.68 1,678.63 21296 424.55 403.32 463.82 21145 1,558.92 1,480.97 1,703.12 21300 151.80 144.21 165.84 21146 1,667.91 1,584.51 1,822.19 # 21300 44.65 42.42 48.78 21147 1,664.43 1,581.21 1,818.39 21310 140.28 133.27 153.26 21150 1,905.01 1,809.76 2,081.22 # 21310 31.60 30.02 34.52 21151 2,334.23 2,217.52 2,550.15 21315 278.00 264.10 303.72 21154 2,433.99 2,312.29 2,659.13 # 21315 158.66 150.73 173.34 21155 2,729.87 2,593.38 2,982.39 21320 276.07 262.27 301.61 21159 3,342.59 3,175.46 3,651.78 # 21320 159.27 151.31 174.01 21160 3,319.77 3,153.78 3,626.85 21325 593.89 564.20 648.83 21172 1,876.73 1,782.89 2,050.32 21330 718.56 682.63 785.02 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 10 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21335 845.63 803.35 923.85 # 21480 35.06 33.31 38.31 21336 727.08 690.73 794.34 21485 587.14 557.78 641.45 21337 424.62 403.39 463.90 # 21485 558.70 530.77 610.39 # 21337 294.61 279.88 321.86 21490 1,006.37 956.05 1,099.46 21338 987.23 937.87 1,078.55 21495 662.75 629.61 724.05 21339 1,048.52 996.09 1,145.50 21497 593.48 563.81 648.38 21340 877.62 833.74 958.80 # 21497 552.34 524.72 603.43 21343 1,331.07 1,264.52 1,454.20 21501 486.70 462.37 531.73 21344 1,672.72 1,589.08 1,827.44 # 21501 354.16 336.45 386.92 21345 843.60 801.42 921.63 21502 589.74 560.25 644.29 # 21345 707.50 672.13 772.95 21510 532.94 506.29 582.23 21346 1,066.81 1,013.47 1,165.49 21550 267.06 253.71 291.77 21347 1,357.94 1,290.04 1,483.55 # 21550 172.09 163.49 188.01 21348 1,280.37 1,216.35 1,398.80 21555 464.88 441.64 507.89 21355 473.26 449.60 517.04 # 21555 346.55 329.22 378.60 # 21355 333.10 316.45 363.92 21556 442.84 420.70 483.81 21356 536.32 509.50 585.93 21557 647.26 614.90 707.14 # 21356 405.30 385.04 442.80 21600 586.29 556.98 640.53 21360 573.41 544.74 626.45 21610 1,099.48 1,044.51 1,201.19 21365 1,178.81 1,119.87 1,287.85 21615 762.76 724.62 833.31 21366 1,334.15 1,267.44 1,457.56 21616 925.65 879.37 1,011.28 21385 804.33 764.11 878.73 21620 594.30 564.59 649.28 21386 742.88 705.74 811.60 21627 612.83 582.19 669.52 21387 862.75 819.61 942.55 21630 1,346.98 1,279.63 1,471.57 21390 815.88 775.09 891.35 21632 1,341.44 1,274.37 1,465.53 21395 991.68 942.10 1,083.42 21685 1,043.10 990.95 1,139.59 21400 191.66 182.08 209.39 21700 476.28 452.47 520.34 # 21400 154.09 146.39 168.35 21705 695.82 661.03 760.18 21401 544.01 516.81 594.33 21720 370.28 351.77 404.54 # 21401 314.98 299.23 344.11 21725 580.91 551.86 634.64 21406 602.35 572.23 658.06 21740 1,138.32 1,081.40 1,243.61 21407 709.90 674.41 775.57 21750 773.17 734.51 844.69 21408 972.81 924.17 1,062.80 21800 107.92 102.52 117.90 21421 694.55 659.82 758.79 21805 280.25 266.24 306.18 # 21421 642.25 610.14 701.66 21810 544.77 517.53 595.16 21422 761.71 723.62 832.16 21820 147.09 139.74 160.70 21423 913.29 867.63 997.77 # 21820 144.04 136.84 157.37 21431 778.38 739.46 850.38 21825 643.16 611.00 702.65 21432 767.63 729.25 838.64 21920 251.33 238.76 274.57 21433 1,896.72 1,801.88 2,072.16 # 21920 158.91 150.96 173.60 21435 1,371.26 1,302.70 1,498.11 21925 453.58 430.90 495.54 21436 2,102.30 1,997.19 2,296.77 # 21925 355.57 337.79 388.46 21440 476.85 453.01 520.96 21930 502.99 477.84 549.52 # 21440 429.12 407.66 468.81 # 21930 385.18 365.92 420.81 21445 726.53 690.20 793.73 21935 1,254.28 1,191.57 1,370.31 # 21445 655.94 623.14 716.61 22010 928.58 882.15 1,014.47 21450 500.43 475.41 546.72 22015 920.72 874.68 1,005.88 # 21450 474.53 450.80 518.42 22100 817.22 776.36 892.81 21451 682.51 648.38 745.64 22101 825.85 784.56 902.24 # 21451 633.76 602.07 692.38 22102 843.39 801.22 921.40 21452 747.55 710.17 816.70 22103 164.09 155.89 179.27 # 21452 318.94 302.99 348.44 22110 1,033.71 982.02 1,129.32 21453 782.09 742.99 854.44 22112 1,036.12 984.31 1,131.96 # 21453 781.59 742.51 853.89 22114 1,037.82 985.93 1,133.82 21454 592.14 562.53 646.91 22116 162.75 154.61 177.80 21461 1,586.81 1,507.47 1,733.59 22210 1,851.55 1,758.97 2,022.82 # 21461 986.05 936.75 1,077.26 22212 1,532.69 1,456.06 1,674.47 21462 1,821.11 1,730.05 1,989.56 22214 1,561.53 1,483.45 1,705.97 # 21462 1,062.42 1,009.30 1,160.70 22216 427.80 406.41 467.37 21465 1,003.08 952.93 1,095.87 22220 1,655.57 1,572.79 1,808.71 21470 1,261.20 1,198.14 1,377.86 22222 1,511.30 1,435.74 1,651.10 21480 115.80 110.01 126.51 22224 1,670.21 1,586.70 1,824.71 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 31140 PAGE 11 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 22226 425.77 404.48 465.15 # 23000 412.37 391.75 450.51 22305 207.85 197.46 227.08 23020 772.80 734.16 844.28 # 22305 188.04 178.64 205.44 23030 524.51 498.28 573.02 22310 257.41 244.54 281.22 # 23030 295.99 281.19 323.37 # 22310 234.56 222.83 256.25 23031 518.99 493.04 567.00 22315 885.09 840.84 966.97 # 23031 257.46 244.59 281.28 # 22315 765.24 726.98 836.03 23035 794.58 754.85 868.08 22318 1,653.90 1,571.21 1,806.89 23040 800.11 760.10 874.12 22319 1,837.62 1,745.74 2,007.60 23044 637.02 605.17 695.95 22325 1,427.08 1,355.73 1,559.09 23065 220.42 209.40 240.81 22326 1,523.24 1,447.08 1,664.14 # 23065 176.24 167.43 192.54 22327 1,479.82 1,405.83 1,616.70 23066 568.84 540.40 621.46 22328 318.90 302.96 348.40 # 23066 380.94 361.89 416.17 22505 129.97 123.47 141.99 23075 288.51 274.08 315.19 22520 3,531.68 3,355.10 3,858.37 # 23075 193.03 183.38 210.89 # 22520 650.78 618.24 710.98 23076 609.62 579.14 666.01 22521 3,216.64 3,055.81 3,514.18 23077 1,207.83 1,147.44 1,319.56 # 22521 618.09 587.19 675.27 23100 549.72 522.23 600.56 22522 274.21 260.50 299.58 23101 513.85 488.16 561.38 22523 686.57 652.24 750.08 23105 720.04 684.04 786.65 22524 658.49 625.57 719.41 23106 548.28 520.87 599.00 22525 308.88 293.44 337.46 23107 750.78 713.24 820.23 22532 1,801.51 1,711.43 1,968.14 23120 637.91 606.01 696.91 22533 1,675.56 1,591.78 1,830.55 23125 792.82 753.18 866.16 22534 420.17 399.16 459.03 23130 690.92 656.37 754.83 22548 1,954.01 1,856.31 2,134.76 23140 562.61 534.48 614.65 22554 1,467.65 1,394.27 1,603.41 23145 771.75 733.16 843.13 22556 1,775.76 1,686.97 1,940.02 23146 702.12 667.01 767.06 22558 1,627.38 1,546.01 1,777.91 23150 717.22 681.36 783.56 22585 389.55 370.07 425.58 23155 873.63 829.95 954.44 22590 1,599.69 1,519.71 1,747.67 23156 752.87 715.23 822.51 22595 1,521.50 1,445.43 1,662.24 23170 603.04 572.89 658.82 22600 1,293.85 1,229.16 1,413.53 23172 615.10 584.35 672.00 22610 1,295.38 1,230.61 1,415.20 23174 838.89 796.95 916.49 22612 1,655.70 1,572.92 1,808.86 23180 828.51 787.08 905.14 22614 456.89 434.05 499.16 23182 788.29 748.88 861.21 22630 1,625.37 1,544.10 1,775.72 23184 882.05 837.95 963.64 22632 368.96 350.51 403.09 23190 626.80 595.46 684.78 22800 1,457.70 1,384.82 1,592.54 23195 819.90 778.91 895.75 22802 2,358.88 2,240.94 2,577.08 23200 965.00 916.75 1,054.26 22804 2,748.71 2,611.27 3,002.96 23210 997.02 947.17 1,089.25 22808 1,980.52 1,881.49 2,163.71 23220 1,182.49 1,123.37 1,291.88 22810 2,246.82 2,134.48 2,454.65 23221 1,366.60 1,298.27 1,493.01 22812 2,432.67 2,311.04 2,657.70 23222 1,837.76 1,745.87 2,007.75 22818 2,366.47 2,248.15 2,585.37 23330 265.87 252.58 290.47 22819 2,637.33 2,505.46 2,881.28 # 23330 174.46 165.74 190.60 22830 886.54 842.21 968.54 23331 666.24 632.93 727.87 22840 890.26 845.75 972.61 23332 979.65 930.67 1,070.27 22842 891.35 846.78 973.80 23350 216.92 206.07 236.98 22843 933.66 886.98 1,020.03 # 23350 57.46 54.59 62.78 22844 1,168.38 1,109.96 1,276.45 23395 1,387.13 1,317.77 1,515.44 22845 847.91 805.51 926.34 23397 1,278.17 1,214.26 1,396.40 22846 881.63 837.55 963.18 23400 1,099.71 1,044.72 1,201.43 22847 971.78 923.19 1,061.67 23405 716.12 680.31 782.36 22848 425.32 404.05 464.66 23406 893.12 848.46 975.73 22849 1,418.03 1,347.13 1,549.20 23410 1,019.72 968.73 1,114.04 22850 779.34 740.37 851.43 23412 1,082.04 1,027.94 1,182.13 22851 470.70 447.17 514.25 23415 840.12 798.11 917.83 22852 745.47 708.20 814.43 23420 1,129.89 1,073.40 1,234.41 22855 1,171.35 1,112.78 1,279.70 23430 846.10 803.80 924.37 22900 409.88 389.39 447.80 23440 875.66 831.88 956.66 23000 621.59 590.51 679.09 23450 1,083.28 1,029.12 1,183.49 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 12 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 23455 1,155.99 1,098.19 1,262.92 23931 378.26 359.35 413.25 23460 1,246.63 1,184.30 1,361.95 # 23931 187.82 178.43 205.19 23462 1,210.68 1,150.15 1,322.67 23935 565.53 537.25 617.84 23465 1,258.28 1,195.37 1,374.68 24000 527.57 501.19 576.37 23466 1,196.59 1,136.76 1,307.27 24006 796.37 756.55 870.03 23470 1,369.15 1,300.69 1,495.79 24065 249.30 236.84 272.37 23472 1,650.55 1,568.02 1,803.22 # 24065 174.65 165.92 190.81 23480 932.49 885.87 1,018.75 24066 678.71 644.77 741.49 23485 1,087.24 1,032.88 1,187.81 # 24066 433.94 412.24 474.08 23490 943.50 896.33 1,030.78 24075 541.45 514.38 591.54 23491 1,162.68 1,104.55 1,270.23 # 24075 340.35 323.33 371.83 23500 235.24 223.48 257.00 24076 517.47 491.60 565.34 # 23500 217.47 206.60 237.59 24077 897.00 852.15 979.97 23505 383.85 364.66 419.36 24100 444.00 421.80 485.07 # 23505 354.91 337.16 387.73 24101 567.62 539.24 620.13 23515 655.48 622.71 716.12 24102 696.77 661.93 761.22 23520 238.35 226.43 260.39 24105 379.70 360.72 414.83 # 23520 232.76 221.12 254.29 24110 660.28 627.27 721.36 23525 383.22 364.06 418.67 24115 785.69 746.41 858.37 # 23525 352.75 335.11 385.38 24116 975.15 926.39 1,065.35 23530 618.10 587.20 675.28 24120 589.23 559.77 643.74 23532 702.81 667.67 767.82 24125 649.07 616.62 709.11 23540 240.37 228.35 262.60 24126 711.69 676.11 777.53 # 23540 214.98 204.23 234.86 24130 577.14 548.28 630.52 23545 349.40 331.93 381.72 24134 872.67 829.04 953.40 # 23545 307.25 291.89 335.67 24136 714.72 678.98 780.83 23550 638.93 606.98 698.03 24138 744.52 707.29 813.38 23552 739.81 702.82 808.24 24140 860.58 817.55 940.18 23570 249.71 237.22 272.80 24145 738.09 701.19 806.37 # 23570 243.62 231.44 266.16 24147 765.18 726.92 835.96 23575 421.74 400.65 460.75 24149 1,205.54 1,145.26 1,317.05 # 23575 392.79 373.15 429.12 24150 1,085.80 1,031.51 1,186.24 23585 778.04 739.14 850.01 24151 1,260.25 1,197.24 1,376.83 23600 358.34 340.42 391.48 24152 823.89 782.70 900.11 # 23600 307.55 292.17 336.00 24153 753.99 716.29 823.73 23605 524.68 498.45 573.22 24155 934.27 887.56 1,020.69 # 23605 471.36 447.79 514.96 24160 689.71 655.22 753.50 23615 856.25 813.44 935.46 24164 563.42 535.25 615.54 23616 1,644.25 1,562.04 1,796.35 24200 247.65 235.27 270.56 23620 287.84 273.45 314.47 # 24200 156.74 148.90 171.24 # 23620 255.85 243.06 279.52 24201 695.93 661.13 760.30 23625 421.66 400.58 460.67 # 24201 411.55 390.97 449.62 # 23625 388.15 368.74 424.05 24220 238.21 226.30 260.25 23630 656.94 624.09 717.70 # 24220 75.70 71.92 82.71 23650 331.94 315.34 362.64 24300 453.72 431.03 495.68 # 23650 280.65 266.62 306.61 24301 856.67 813.84 935.92 23655 408.16 387.75 445.91 24305 661.97 628.87 723.20 23660 650.23 617.72 710.38 24310 542.23 515.12 592.39 23665 464.14 440.93 507.07 24320 839.51 797.53 917.16 # 23665 432.66 411.03 472.68 24330 816.81 775.97 892.37 23670 690.89 656.35 754.80 24331 902.43 857.31 985.91 23675 609.69 579.21 666.09 24332 666.99 633.64 728.69 # 23675 558.91 530.96 610.60 24340 698.12 663.21 762.69 23680 849.85 807.36 928.46 24341 746.24 708.93 815.27 23700 220.41 209.39 240.80 24342 895.10 850.35 977.90 23800 1,142.77 1,085.63 1,248.47 24343 789.07 749.62 862.06 23802 1,234.93 1,173.18 1,349.16 24344 1,193.11 1,133.45 1,303.47 23900 1,446.96 1,374.61 1,580.80 24345 782.71 743.57 855.11 23920 1,138.26 1,081.35 1,243.55 24346 1,183.23 1,124.07 1,292.68 23921 492.67 468.04 538.25 24350 511.38 485.81 558.68 23930 447.89 425.50 489.33 24351 558.23 530.32 609.87 # 23930 243.74 231.55 266.28 24352 593.81 564.12 648.74 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 31140 PAGE 13 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 24354 593.51 563.83 648.40 24800 924.10 877.90 1,009.59 24356 610.46 579.94 666.93 24802 1,123.31 1,067.14 1,227.21 24360 1,016.25 965.44 1,110.26 24900 773.45 734.78 845.00 24361 1,144.08 1,086.88 1,249.91 24920 766.97 728.62 837.91 24362 1,162.71 1,104.57 1,270.26 24925 614.82 584.08 671.69 24363 1,496.60 1,421.77 1,635.04 24930 811.14 770.58 886.17 24365 730.13 693.62 797.66 24931 836.26 794.45 913.62 24366 779.14 740.18 851.21 24935 1,070.38 1,016.86 1,169.39 24400 931.35 884.78 1,017.50 25000 495.65 470.87 541.50 24410 1,169.01 1,110.56 1,277.14 25001 361.07 343.02 394.47 24420 1,116.69 1,060.86 1,219.99 25020 741.76 704.67 810.37 24430 1,052.34 999.72 1,149.68 25023 1,318.36 1,252.44 1,440.31 24435 1,125.84 1,069.55 1,229.98 25024 786.15 746.84 858.87 24470 772.00 733.40 843.41 25025 1,200.71 1,140.67 1,311.77 24495 792.58 752.95 865.89 25028 640.92 608.87 700.20 24498 989.36 939.89 1,080.87 25031 580.75 551.71 634.47 24500 385.05 365.80 420.67 25035 1,011.06 960.51 1,104.59 # 24500 325.63 309.35 355.75 25040 681.34 647.27 744.36 24505 560.53 532.50 612.38 25065 245.78 233.49 268.51 # 24505 499.09 474.14 545.26 # 25065 178.75 169.81 195.28 24515 983.87 934.68 1,074.88 25066 536.93 510.08 586.59 24516 970.16 921.65 1,059.90 25075 460.00 437.00 502.55 24530 416.04 395.24 454.53 25076 696.84 662.00 761.30 # 24530 356.62 338.79 389.61 25077 1,032.95 981.30 1,128.50 24535 697.34 662.47 761.84 25085 598.90 568.96 654.30 # 24535 635.38 603.61 694.15 25100 435.78 413.99 476.09 24538 853.28 810.62 932.21 25101 502.20 477.09 548.65 24545 884.53 840.30 966.35 25105 623.49 592.32 681.17 24546 1,258.37 1,195.45 1,374.77 25107 700.79 665.75 765.61 24560 348.70 331.27 380.96 25110 527.70 501.32 576.52 # 24560 283.19 269.03 309.38 25111 384.84 365.60 420.44 24565 577.33 548.46 630.73 25112 462.19 439.08 504.94 # 24565 521.97 495.87 570.25 25115 1,092.39 1,037.77 1,193.44 24566 752.64 715.01 822.26 25116 975.19 926.43 1,065.39 24575 890.82 846.28 973.22 25118 480.30 456.29 524.73 24576 365.76 347.47 399.59 25119 647.17 614.81 707.03 # 24576 312.44 296.82 341.34 25120 879.03 835.08 960.34 24577 603.09 572.94 658.88 25125 973.23 924.57 1,063.26 # 24577 547.74 520.35 598.40 25126 989.79 940.30 1,081.35 24579 953.98 906.28 1,042.22 25130 552.70 525.07 603.83 24582 835.64 793.86 912.94 25135 677.42 643.55 740.08 24586 1,232.76 1,171.12 1,346.79 25136 594.86 565.12 649.89 24587 1,217.17 1,156.31 1,329.76 25145 888.34 843.92 970.51 24600 425.17 403.91 464.50 25150 723.77 687.58 790.72 # 24600 356.11 338.30 389.05 25151 966.57 918.24 1,055.98 24605 507.37 482.00 554.30 25170 1,249.27 1,186.81 1,364.83 24615 806.71 766.37 881.33 25210 600.53 570.50 656.08 24620 618.20 587.29 675.38 25215 784.31 745.09 856.85 24635 1,288.36 1,223.94 1,407.53 25230 537.06 510.21 586.74 24640 143.98 136.78 157.30 25240 576.33 547.51 629.64 # 24640 90.66 86.13 99.05 25246 234.30 222.59 255.98 24650 285.82 271.53 312.26 # 25246 83.47 79.30 91.20 # 24650 233.52 221.84 255.12 25248 652.67 620.04 713.05 24655 492.64 468.01 538.21 25250 594.19 564.48 649.15 # 24655 433.22 411.56 473.29 25251 809.28 768.82 884.14 24665 736.07 699.27 804.16 25259 453.49 430.82 495.44 24666 822.64 781.51 898.74 25260 1,012.86 962.22 1,106.55 24670 318.97 303.02 348.47 25263 1,010.86 960.32 1,104.37 # 24670 266.15 252.84 290.77 25265 1,152.14 1,094.53 1,258.71 24675 510.44 484.92 557.66 25270 870.83 827.29 951.38 # 24675 457.63 434.75 499.96 25272 954.67 906.94 1,042.98 24685 765.18 726.92 835.96 25274 1,070.06 1,016.56 1,169.04 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 14 FSY06 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 01/12/06 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 25275 751.28 713.72 820.78 # 25560 236.88 225.04 258.80 25280 952.87 905.23 1,041.01 25565 584.64 555.41 638.72 25290 990.60 941.07 1,082.23 # 25565 519.64 493.66 567.71 25295 900.24 855.23 983.51 25574 671.07 637.52 733.15 25300 805.99 765.69 880.54 25575 938.23 891.32 1,025.02 25301 771.24 732.68 842.58 25600 321.73 305.64 351.49 25310 1,012.47 961.85 1,106.13 # 25600 264.85 251.61 289.35 25312 1,119.71 1,063.72 1,223.28 25605 620.34 589.32 677.72 25315 1,171.58 1,113.00 1,279.95 # 25605 569.05 540.60 621.69 25316 1,352.01 1,284.41 1,477.07 25611 793.97 754.27 867.41 25320 1,041.32 989.25 1,137.64 25620 739.70 702.72 808.13 25332 959.11 911.15 1,047.82 25622 329.84 313.35 360.35 25335 1,141.88 1,084.79 1,247.51 # 25622 270.42 256.90 295.44 25337 1,002.04 951.94 1,094.73 25624 516.99 491.14 564.81 25350 1,091.48 1,036.91 1,192.45 # 25624 454.02 431.32 496.02 25355 1,184.77 1,125.53 1,294.36 25628 762.20 724.09 832.70 25360 1,071.44 1,017.87 1,170.55 25630 336.85 320.01 368.01 25365 1,335.42 1,268.65 1,458.95 # 25630 273.88 260.19 299.22 25370 1,398.11 1,328.20 1,527.43 25635 492.72 468.08 538.29 25375 1,402.84 1,332.70 1,532.61 # 25635 388.62 369.19 424.57 25390 1,190.29 1,130.78 1,300.40 25645 651.29 618.73 711.54 25391 1,432.14 1,360.53 1,564.61 25650 350.12 332.61 382.50 25392 1,411.23 1,340.67 1,541.77 # 25650 292.22 277.61 319.25 25393 1,585.09 1,505.84 1,731.72 25651 510.37 484.85 557.58 25394 856.70 813.87 935.95 25652 684.06 649.86 747.34 25400 1,245.86 1,183.57 1,361.11 25660 440.32 418.30 481.05 25405 1,500.05 1,425.05 1,638.81 25670 697.83 662.94 762.38 25415 1,417.35 1,346.48 1,548.45 25671 572.95 544.30 625.95 25420 1,634.47 1,552.75 1,785.66 25675 486.02 461.72 530.98 25425 1,657.97 1,575.07 1,811.33 # 25675 434.73 412.99 474.94 25426 1,525.39 1,449.12 1,666.49 25676 719.76 683.77 786.34 25430 767.52 729.14 838.51 25680 495.02 470.27 540.81 25431 883.18 839.02 964.87 25685 819.81 778.82 895.64