1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 1 FSY06 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 02/01/06 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 127.03 120.68 138.78 D0421 9.26 8.80 10.12 G0182 134.21 127.50 146.63 D0431 9.26 8.80 10.12 G0186 366.43 348.11 400.33 D0475 18.81 17.87 20.55 G0202 140.43 133.41 153.42 D0476 81.52 77.44 89.06 G0202 TC 103.70 98.52 113.30 D0477 59.12 56.16 64.58 G0202 26 36.73 34.89 40.12 D0478 99.71 94.72 108.93 G0204 147.60 140.22 161.25 D0479 131.38 124.81 143.53 G0204 TC 102.11 97.00 111.55 D0481 430.82 409.28 470.67 G0204 26 45.49 43.22 49.70 D0482 96.27 91.46 105.18 G0206 119.40 113.43 130.44 D0483 84.01 79.81 91.78 G0206 TC 82.68 78.55 90.33 D0484 82.23 78.12 89.84 G0206 26 36.73 34.89 40.12 # D0484 73.14 69.48 79.90 G0237 19.31 18.34 21.09 D0485 123.82 117.63 135.27 G0238 20.11 19.10 21.97 D7288 144.16 136.95 157.49 G0239 13.72 13.03 14.98 # D7288 97.91 93.01 106.96 G0245 66.22 62.91 72.35 D7321 321.46 305.39 351.20 # G0245 47.07 44.72 51.43 # D7321 255.45 242.68 279.08 G0246 39.28 37.32 42.92 D7511 264.06 250.86 288.49 # G0246 24.11 22.90 26.34 # D7511 213.47 202.80 233.22 G0247 40.39 38.37 44.13 D7521 150.36 142.84 164.27 # G0247 28.02 26.62 30.61 # D7521 98.58 93.65 107.70 G0248 264.86 251.62 289.36 G0101 38.48 36.56 42.04 G0249 158.70 150.77 173.39 # G0101 24.51 23.28 26.77 G0250 9.54 9.06 10.42 G0102 22.33 21.21 24.39 G0268 48.98 46.53 53.51 # G0102 9.16 8.70 10.01 # G0268 33.41 31.74 36.50 G0104 129.84 123.35 141.85 G0270 19.03 18.08 20.79 # G0104 58.81 55.87 64.25 G0271 7.46 7.09 8.15 G0105 394.98 375.23 431.51 G0275 13.81 13.12 15.09 # G0105 207.82 197.43 227.04 G0278 13.81 13.12 15.09 G0105 53 129.84 123.35 141.85 G0281 11.54 10.96 12.60 # G0105 53 58.81 55.87 64.25 G0283 11.54 10.96 12.60 G0106 144.66 137.43 158.04 G0288 429.60 408.12 469.34 G0106 TC 93.00 88.35 101.60 G0289 95.63 90.85 104.48 G0106 26 51.66 49.08 56.44 G0308 839.46 797.49 917.11 G0108 33.40 31.73 36.49 G0309 699.04 664.09 763.70 G0109 19.43 18.46 21.23 G0310 559.24 531.28 610.97 G0117 46.18 43.87 50.45 G0311 569.52 541.04 622.20 # G0117 25.03 23.78 27.35 G0312 474.39 450.67 518.27 G0118 27.92 26.52 30.50 G0313 379.49 360.52 414.60 # G0118 9.16 8.70 10.01 G0314 500.27 475.26 546.55 G0120 144.66 137.43 158.04 G0315 416.57 395.74 455.10 G0120 TC 93.00 88.35 101.60 G0316 333.10 316.45 363.92 G0120 26 51.66 49.08 56.44 G0317 313.50 297.83 342.50 G0121 394.98 375.23 431.51 G0318 261.07 248.02 285.22 # G0121 207.82 197.43 227.04 G0319 208.65 198.22 227.95 G0121 53 129.84 123.35 141.85 G0320 699.04 664.09 763.70 # G0121 53 58.81 55.87 64.25 G0321 474.39 450.67 518.27 G0124 22.57 21.44 24.66 G0322 416.57 395.74 455.10 G0127 16.74 15.90 18.29 G0323 261.07 248.02 285.22 # G0127 9.56 9.08 10.44 G0324 23.21 22.05 25.36 G0128 4.53 4.30 4.95 G0325 13.84 13.15 15.12 G0130 44.78 42.54 48.92 G0326 15.77 14.98 17.23 G0130 TC 33.31 31.64 36.39 G0327 8.81 8.37 9.63 G0130 26 11.47 10.90 12.54 G0329 8.15 7.74 8.90 G0141 22.57 21.44 24.66 # G0329 3.37 3.20 3.68 G0166 145.81 138.52 159.30 G0332 76.22 72.41 83.27 # G0166 4.15 3.94 4.53 G0341 509.17 483.71 556.27 G0168 95.42 90.65 104.25 # G0341 383.47 364.30 418.95 # G0168 26.79 25.45 29.27 G0342 707.36 671.99 772.79 G0179 58.83 55.89 64.27 G0343 1,165.13 1,106.87 1,272.90 G0180 76.68 72.85 83.78 G0344 99.01 94.06 108.17 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 99 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 73.07 69.42 79.83 11006 710.73 675.19 776.47 G0364 12.80 12.16 13.98 11008 288.77 274.33 315.48 # G0364 9.61 9.13 10.50 11010 453.19 430.53 495.11 G0365 176.11 167.30 192.40 # 11010 283.19 269.03 309.38 G0365 TC 162.42 154.30 177.45 11011 535.51 508.73 585.04 G0365 26 13.69 13.01 14.96 # 11011 302.86 287.72 330.88 G0366 27.67 26.29 30.23 11012 778.86 739.92 850.91 G0367 18.51 17.58 20.22 # 11012 448.04 425.64 489.49 G0368 9.16 8.70 10.01 11040 41.50 39.43 45.34 G0372 22.33 21.21 24.39 # 11040 29.13 27.67 31.82 # G0372 9.16 8.70 10.01 11041 60.41 57.39 66.00 G0375 13.03 12.38 14.24 # 11041 47.24 44.88 51.61 G0376 25.78 24.49 28.16 11042 85.06 80.81 92.93 # G0376 25.38 24.11 27.73 # 11042 63.91 60.71 69.82 M0064 27.97 26.57 30.56 11043 235.00 223.25 256.74 # M0064 19.19 18.23 20.96 # 11043 203.47 193.30 222.30 P3001 22.57 21.44 24.66 11044 306.70 291.37 335.08 Q0035 25.28 24.02 27.62 # 11044 278.77 264.83 304.55 Q0035 TC 16.12 15.31 17.61 11055 40.15 38.14 43.86 Q0035 26 9.16 8.70 10.01 # 11055 24.58 23.35 26.85 Q0091 41.41 39.34 45.24 11056 50.76 48.22 55.45 # Q0091 20.26 19.25 22.14 # 11056 34.40 32.68 37.58 Q0092 13.05 12.40 14.26 11057 62.46 59.34 68.24 R0070 174.06 165.36 190.16 # 11057 44.90 42.66 49.06 R0075 174.06 165.36 190.16 11100 81.63 77.55 89.18 0016T 366.43 348.11 400.33 # 11100 46.51 44.18 50.81 0024T 607.04 576.69 663.19 11101 29.37 27.90 32.09 0030T 26.60 25.27 29.06 # 11101 23.78 22.59 25.98 0067T 440.14 418.13 480.85 11200 72.00 68.40 78.66 0067T TC 376.99 358.14 411.86 # 11200 60.83 57.79 66.46 0067T 26 63.15 59.99 68.99 11201 18.01 17.11 19.68 0073T 724.71 688.47 791.74 # 11201 16.41 15.59 17.93 10021 137.44 130.57 150.16 11300 59.80 56.81 65.33 # 10021 72.79 69.15 79.52 # 11300 28.68 27.25 31.34 10022 152.45 144.83 166.55 11301 77.85 73.96 85.05 # 10022 67.45 64.08 73.69 # 11301 48.71 46.27 53.21 10040 86.73 82.39 94.75 11302 93.34 88.67 101.97 # 10040 77.95 74.05 85.16 # 11302 59.82 56.83 65.35 10060 96.27 91.46 105.18 11303 112.32 106.70 122.71 # 10060 85.10 80.85 92.98 # 11303 70.02 66.52 76.50 10061 171.84 163.25 187.74 11305 61.43 58.36 67.11 # 10061 158.67 150.74 173.35 # 11305 38.29 36.38 41.84 10080 171.81 163.22 187.70 11306 83.62 79.44 91.36 # 10080 92.00 87.40 100.51 # 11306 56.49 53.67 61.72 10081 262.98 249.83 287.30 11307 96.93 92.08 105.89 # 10081 160.02 152.02 174.82 # 11307 65.00 61.75 71.01 10120 136.89 130.05 149.56 11308 115.28 109.52 125.95 # 10120 88.60 84.17 96.80 # 11308 80.97 76.92 88.46 10121 252.29 239.68 275.63 11310 73.27 69.61 80.05 # 10121 183.26 174.10 200.22 # 11310 41.74 39.65 45.60 10140 134.70 127.97 147.17 11311 90.54 86.01 98.91 # 10140 115.15 109.39 125.80 # 11311 61.01 57.96 66.65 10160 113.53 107.85 124.03 11312 104.13 98.92 113.76 # 10160 92.78 88.14 101.36 # 11312 69.41 65.94 75.83 10180 214.91 204.16 234.78 11313 136.83 129.99 149.49 # 10180 175.00 166.25 191.19 # 11313 93.33 88.66 101.96 11000 47.99 45.59 52.43 11400 113.92 108.22 124.45 # 11000 33.62 31.94 36.73 # 11400 69.22 65.76 75.62 11001 21.74 20.65 23.75 11401 131.92 125.32 144.12 # 11001 16.95 16.10 18.52 # 11401 90.42 85.90 98.79 11004 568.10 539.70 620.66 11402 150.23 142.72 164.13 11005 774.08 735.38 845.69 # 11402 104.34 99.12 113.99 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 3 FSY06 LOCALITY FEE SCHEDULE FOR AREA 99 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 168.81 160.37 184.43 11624 273.93 260.23 299.26 # 11403 125.71 119.42 137.33 # 11624 195.31 185.54 213.37 11404 192.59 182.96 210.40 11626 361.38 343.31 394.81 # 11404 140.32 133.30 153.30 # 11626 271.99 258.39 297.15 11406 236.73 224.89 258.62 11640 160.73 152.69 175.59 # 11406 180.06 171.06 196.72 # 11640 98.87 93.93 108.02 11420 110.53 105.00 120.75 11641 207.79 197.40 227.01 # 11420 77.01 73.16 84.13 # 11641 147.93 140.53 161.61 11421 140.41 133.39 153.40 11642 240.20 228.19 262.42 # 11421 102.10 97.00 111.55 # 11642 172.36 163.74 188.30 11422 156.84 149.00 171.35 11643 277.57 263.69 303.24 # 11422 119.73 113.74 130.80 # 11643 204.14 193.93 223.02 11423 185.62 176.34 202.79 11644 350.85 333.31 383.31 # 11423 140.13 133.12 153.09 # 11644 261.86 248.77 286.09 11424 211.82 201.23 231.41 11646 473.89 450.20 517.73 # 11424 163.53 155.35 178.65 # 11646 382.51 363.38 417.89 11426 295.37 280.60 322.69 11719 17.02 16.17 18.60 # 11426 240.30 228.29 262.53 # 11719 9.84 9.35 10.75 11440 130.87 124.33 142.98 11720 26.89 25.55 29.38 # 11440 94.95 90.20 103.73 # 11720 18.11 17.20 19.78 11441 153.47 145.80 167.67 11721 40.11 38.10 43.82 # 11441 119.55 113.57 130.61 # 11721 30.93 29.38 33.79 11442 171.85 163.26 187.75 11730 88.12 83.71 96.27 # 11442 132.74 126.10 145.02 # 11730 64.17 60.96 70.10 11443 210.03 199.53 229.46 11732 41.26 39.20 45.08 # 11443 166.13 157.82 181.49 # 11732 32.48 30.86 35.49 11444 267.04 253.69 291.74 11740 37.18 35.32 40.62 # 11444 215.56 204.78 235.50 # 11740 29.20 27.74 31.90 11446 344.53 327.30 376.40 11750 163.69 155.51 178.84 # 11446 293.85 279.16 321.03 # 11750 147.33 139.96 160.95 11450 314.76 299.02 343.87 11752 231.34 219.77 252.74 # 11450 194.64 184.91 212.65 11755 116.53 110.70 127.31 11451 429.26 407.80 468.97 # 11755 84.61 80.38 92.44 # 11451 266.84 253.50 291.53 11760 171.08 162.53 186.91 11462 309.00 293.55 337.58 # 11760 137.56 130.68 150.28 # 11462 185.29 176.03 202.43 11762 235.62 223.84 257.42 11463 438.32 416.40 478.86 # 11762 214.07 203.37 233.88 # 11463 272.71 259.07 297.93 11765 99.99 94.99 109.24 11470 337.46 320.59 368.68 # 11765 58.88 55.94 64.33 # 11470 225.73 214.44 246.61 11770 248.04 235.64 270.99 11471 452.20 429.59 494.03 # 11770 168.63 160.20 184.23 # 11471 294.57 279.84 321.82 11771 465.10 441.85 508.13 11600 158.12 150.21 172.74 # 11771 371.72 353.13 406.10 # 11600 91.48 86.91 99.95 11772 590.81 561.27 645.46 11601 180.17 171.16 196.83 # 11772 493.44 468.77 539.09 # 11601 120.71 114.67 131.87 11900 46.34 44.02 50.62 11602 190.69 181.16 208.33 # 11900 28.78 27.34 31.44 # 11602 128.03 121.63 139.87 11901 57.70 54.82 63.04 11603 210.93 200.38 230.44 # 11901 45.33 43.06 49.52 # 11603 141.10 134.05 154.16 11920 216.16 205.35 236.15 11604 232.03 220.43 253.49 # 11920 111.61 106.03 121.93 # 11604 152.62 144.99 166.74 11921 240.14 228.13 262.35 11606 302.93 287.78 330.95 # 11921 132.39 125.77 144.64 # 11606 209.95 199.45 229.37 11922 66.14 62.83 72.25 11620 151.67 144.09 165.70 # 11922 30.62 29.09 33.45 # 11620 85.82 81.53 93.76 11950 79.22 75.26 86.55 11621 178.65 169.72 195.18 # 11950 49.29 46.83 53.85 # 11621 119.98 113.98 131.08 11951 107.93 102.53 117.91 11622 202.17 192.06 220.87 # 11951 68.82 65.38 75.19 # 11622 139.12 132.16 151.98 11952 143.17 136.01 156.41 11623 238.45 226.53 260.51 # 11952 96.08 91.28 104.97 # 11623 168.21 159.80 183.77 11954 175.32 166.55 191.53 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 4 FSY06 LOCALITY FEE SCHEDULE FOR AREA 99 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 113.46 107.79 123.96 # 12045 241.31 229.24 263.63 11960 798.35 758.43 872.19 12046 437.00 415.15 477.42 11970 543.64 516.46 593.93 # 12046 286.95 272.60 313.49 11971 454.92 432.17 497.00 12047 446.99 424.64 488.34 # 11971 241.82 229.73 264.19 # 12047 316.50 300.68 345.78 11976 142.40 135.28 155.57 12051 230.71 219.17 252.05 # 11976 100.90 95.86 110.24 # 12051 157.68 149.80 172.27 11980 103.19 98.03 112.73 12052 239.33 227.36 261.46 # 11980 81.64 77.56 89.19 # 12052 167.50 159.13 183.00 11981 127.65 121.27 139.46 12053 255.15 242.39 278.75 # 11981 86.95 82.60 94.99 # 12053 186.51 177.18 203.76 11982 150.47 142.95 164.39 12054 282.46 268.34 308.59 # 11982 105.77 100.48 115.55 # 12054 205.04 194.79 224.01 11983 223.71 212.52 244.40 12055 360.36 342.34 393.69 # 11983 190.99 181.44 208.66 # 12055 266.18 252.87 290.80 12001 148.46 141.04 162.20 12056 486.14 461.83 531.10 # 12001 99.77 94.78 109.00 # 12056 338.09 321.19 369.37 12002 157.51 149.63 172.07 12057 488.05 463.65 533.20 # 12002 111.62 106.04 121.95 # 12057 392.67 373.04 429.00 12004 184.30 175.09 201.35 13100 288.31 273.89 314.97 # 12004 131.62 125.04 143.80 # 13100 218.47 207.55 238.68 12005 229.58 218.10 250.82 13101 342.80 325.66 374.51 # 12005 164.53 156.30 179.75 # 13101 263.79 250.60 288.19 12006 285.08 270.83 311.45 13102 97.62 92.74 106.65 # 12006 209.66 199.18 229.06 # 13102 73.68 70.00 80.50 12007 322.19 306.08 351.99 13120 298.77 283.83 326.40 # 12007 241.98 229.88 264.36 # 13120 226.94 215.59 247.93 12011 157.01 149.16 171.53 13121 365.75 347.46 399.58 # 12011 102.74 97.60 112.24 # 13121 283.54 269.36 309.76 12013 171.93 163.33 187.83 13122 119.38 113.41 130.42 # 12013 118.06 112.16 128.98 # 13122 84.26 80.05 92.06 12014 203.23 193.07 222.03 13131 325.87 309.58 356.02 # 12014 142.57 135.44 155.76 # 13131 258.83 245.89 282.77 12015 255.10 242.35 278.70 13132 471.82 448.23 515.46 # 12015 179.68 170.70 196.31 # 13132 401.98 381.88 439.16 12016 301.94 286.84 329.87 13133 154.82 147.08 169.14 # 12016 220.53 209.50 240.93 # 13133 129.68 123.20 141.68 12017 268.24 254.83 293.05 13150 349.20 331.74 381.50 12018 318.62 302.69 348.09 # 13150 265.00 251.75 289.51 12020 261.16 248.10 285.32 13151 370.00 351.50 404.23 # 12020 185.34 176.07 202.48 # 13151 303.76 288.57 331.86 12021 149.91 142.41 163.77 13152 493.73 469.04 539.40 # 12021 133.15 126.49 145.46 # 13152 413.92 393.22 452.20 12031 178.16 169.25 194.64 13153 174.91 166.16 191.08 # 12031 125.08 118.83 136.65 # 13153 142.99 135.84 156.22 12032 252.35 239.73 275.69 13160 728.49 692.07 795.88 # 12032 170.54 162.01 186.31 14000 554.85 527.11 606.18 12034 246.08 233.78 268.85 # 14000 459.47 436.50 501.98 # 12034 176.24 167.43 192.54 14001 722.35 686.23 789.16 12035 349.26 331.80 381.57 # 14001 628.57 597.14 686.71 # 12035 227.55 216.17 248.60 14020 613.28 582.62 670.01 12036 391.73 372.14 427.96 # 14020 530.27 503.76 579.32 # 12036 271.22 257.66 296.31 14021 805.11 764.85 879.58 12037 440.00 418.00 480.70 # 14021 736.88 700.04 805.05 # 12037 314.69 298.96 343.80 14040 669.55 636.07 731.48 12041 197.48 187.61 215.75 # 14040 605.30 575.04 661.30 # 12041 140.82 133.78 153.85 14041 881.81 837.72 963.38 12042 239.78 227.79 261.96 # 14041 805.19 764.93 879.67 # 12042 167.55 159.17 183.05 14060 694.46 659.74 758.70 12044 255.83 243.04 279.50 # 14060 640.19 608.18 699.41 # 12044 191.18 181.62 208.86 14061 953.48 905.81 1,041.68 12045 360.62 342.59 393.98 # 14061 869.67 826.19 950.12 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 99 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 925.61 879.33 1,011.23 # 15221 72.21 68.60 78.89 # 14300 847.39 805.02 925.77 15240 778.41 739.49 850.41 14350 689.31 654.84 753.07 # 15240 688.22 653.81 751.88 15000 318.91 302.96 348.40 15241 175.14 166.38 191.34 # 15000 254.66 241.93 278.22 # 15241 113.69 108.01 124.21 15001 95.93 91.13 104.80 15260 810.96 770.41 885.97 # 15001 58.41 55.49 63.81 # 15260 745.51 708.23 814.46 15040 265.36 252.09 289.90 15261 198.68 188.75 217.06 # 15040 128.09 121.69 139.94 # 15261 146.81 139.47 160.39 15050 456.10 433.30 498.30 15300 293.98 279.28 321.17 # 15050 383.87 364.68 419.38 # 15300 255.27 242.51 278.89 15100 884.16 839.95 965.94 15301 60.81 57.77 66.44 # 15100 693.41 658.74 757.55 # 15301 58.01 55.11 63.38 15101 221.56 210.48 242.05 15320 340.34 323.32 371.82 # 15101 119.00 113.05 130.01 # 15320 296.84 282.00 324.30 15110 825.93 784.63 902.32 15321 90.61 86.08 98.99 # 15110 679.08 645.13 741.90 # 15321 86.62 82.29 94.63 15111 129.30 122.84 141.27 15330 293.58 278.90 320.74 # 15111 109.35 103.88 119.46 # 15330 254.87 242.13 278.45 15115 775.45 736.68 847.18 15331 60.41 57.39 66.00 # 15115 700.43 665.41 765.22 # 15331 58.01 55.11 63.38 15116 167.63 159.25 183.14 15335 325.88 309.59 356.03 # 15116 149.27 141.81 163.08 # 15335 284.78 270.54 311.12 15120 835.97 794.17 913.30 15336 87.66 83.28 95.77 # 15120 718.25 682.34 784.69 # 15336 82.88 78.74 90.55 15121 291.87 277.28 318.87 15340 313.38 297.71 342.37 # 15121 185.72 176.43 202.89 # 15340 263.50 250.33 287.88 15130 688.76 654.32 752.47 15341 45.09 42.84 49.27 # 15130 547.89 520.50 598.58 # 15341 28.73 27.29 31.38 15131 105.78 100.49 115.56 15360 338.41 321.49 369.71 # 15131 88.62 84.19 96.82 # 15360 282.94 268.79 309.11 15135 829.95 788.45 906.72 15361 70.92 67.37 77.48 # 15135 760.11 722.10 830.42 # 15361 66.13 62.82 72.24 15136 98.32 93.40 107.41 15365 353.13 335.47 385.79 # 15136 89.54 85.06 97.82 # 15365 298.85 283.91 326.50 15150 684.91 650.66 748.26 15366 87.99 83.59 96.13 # 15150 604.30 574.09 660.20 # 15366 83.20 79.04 90.90 15151 136.38 129.56 148.99 15400 325.75 309.46 355.88 # 15151 118.02 112.12 128.94 15401 117.87 111.98 128.78 15152 167.38 159.01 182.86 # 15401 59.61 56.63 65.12 # 15152 147.43 140.06 161.07 15420 377.33 358.46 412.23 15155 685.50 651.23 748.91 # 15420 337.82 320.93 369.07 # 15155 651.18 618.62 711.41 15421 115.75 109.96 126.45 15156 177.20 168.34 193.59 # 15421 87.82 83.43 95.94 # 15156 164.43 156.21 179.64 15430 513.92 488.22 561.45 15157 196.35 186.53 214.51 # 15430 502.35 477.23 548.81 # 15157 179.20 170.24 195.78 15570 840.46 798.44 918.21 15170 359.33 341.36 392.56 # 15570 658.88 625.94 719.83 # 15170 300.67 285.64 328.49 15572 766.63 728.30 837.55 15171 91.57 86.99 100.04 # 15572 644.91 612.66 704.56 # 15171 89.17 84.71 97.42 15574 837.40 795.53 914.86 15175 507.01 481.66 553.91 # 15574 721.67 685.59 788.43 # 15175 449.94 427.44 491.56 15576 745.70 708.42 814.68 15176 145.85 138.56 159.34 # 15576 630.77 599.23 689.11 # 15176 141.06 134.01 154.11 15600 384.48 365.26 420.05 15200 709.60 674.12 775.24 # 15600 202.90 192.76 221.67 # 15200 581.50 552.43 635.29 15610 289.64 275.16 316.43 15201 158.21 150.30 172.85 # 15610 238.95 227.00 261.05 # 15201 80.39 76.37 87.83 15620 433.19 411.53 473.26 15220 690.83 656.29 754.73 # 15620 277.16 263.30 302.80 # 15220 590.66 561.13 645.30 15630 415.97 395.17 454.45 15221 142.84 135.70 156.06 # 15630 300.25 285.24 328.03 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 6 FSY06 LOCALITY FEE SCHEDULE FOR AREA 99 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 448.52 426.09 490.00 # 15839 647.27 614.91 707.15 # 15650 331.20 314.64 361.84 15840 941.00 893.95 1,028.04 15732 1,456.86 1,384.02 1,591.62 15841 1,556.87 1,479.03 1,700.88 # 15732 1,223.81 1,162.62 1,337.01 15842 2,500.36 2,375.34 2,731.64 15734 1,474.97 1,401.22 1,611.40 15845 873.77 830.08 954.59 # 15734 1,245.51 1,183.23 1,360.71 15851 101.53 96.45 110.92 15736 1,417.69 1,346.81 1,548.83 # 15851 46.86 44.52 51.20 # 15736 1,137.15 1,080.29 1,242.33 15852 109.15 103.69 119.24 15738 1,475.45 1,401.68 1,611.93 # 15852 48.49 46.07 52.98 # 15738 1,225.24 1,163.98 1,338.58 15860 115.04 109.29 125.68 15740 813.35 772.68 888.58 # 15860 113.04 107.39 123.50 # 15740 738.33 701.41 806.62 15920 554.18 526.47 605.44 15750 836.07 794.27 913.41 15922 705.40 670.13 770.65 15756 2,293.49 2,178.82 2,505.64 15931 614.43 583.71 671.27 15757 2,314.59 2,198.86 2,528.69 15933 769.59 731.11 840.78 15758 2,318.28 2,202.37 2,532.73 15934 854.61 811.88 933.66 15760 757.83 719.94 827.93 15935 1,026.35 975.03 1,121.28 # 15760 647.29 614.93 707.17 15936 849.41 806.94 927.98 15770 583.14 553.98 637.08 15937 991.83 942.24 1,083.58 15775 334.39 317.67 365.32 15940 639.47 607.50 698.63 # 15775 217.07 206.22 237.15 15941 859.86 816.87 939.40 15776 445.34 423.07 486.53 15944 826.41 785.09 902.85 # 15776 343.18 326.02 374.92 15945 920.53 874.50 1,005.68 15780 757.35 719.48 827.40 15946 1,484.85 1,410.61 1,622.20 # 15780 626.46 595.14 684.41 15950 532.95 506.30 582.25 15781 470.70 447.17 514.25 15951 764.19 725.98 834.88 # 15781 408.85 388.41 446.67 15952 788.43 749.01 861.36 15782 568.20 539.79 620.76 15953 890.91 846.36 973.31 # 15782 436.11 414.30 476.45 15956 1,083.90 1,029.71 1,184.17 15783 446.07 423.77 487.34 15958 1,094.26 1,039.55 1,195.48 # 15783 338.32 321.40 369.61 16000 70.51 66.98 77.03 15786 214.61 203.88 234.46 # 16000 46.56 44.23 50.86 # 15786 133.20 126.54 145.52 16020 84.23 80.02 92.02 15787 57.20 54.34 62.49 # 16020 55.90 53.11 61.08 # 15787 20.09 19.09 21.95 16025 146.51 139.18 160.06 15788 351.38 333.81 383.88 # 16025 114.19 108.48 124.75 # 15788 206.13 195.82 225.19 16030 173.04 164.39 189.05 15789 516.57 490.74 564.35 # 16030 130.74 124.20 142.83 # 15789 384.88 365.64 420.49 16035 218.56 207.63 238.77 15792 358.33 340.41 391.47 16036 86.74 82.40 94.76 # 15792 252.58 239.95 275.94 17000 62.44 59.32 68.22 15793 399.03 379.08 435.94 # 17000 45.28 43.02 49.47 # 15793 322.81 306.67 352.67 17003 10.39 9.87 11.35 15819 671.85 638.26 734.00 # 17003 8.80 8.36 9.61 15820 486.21 461.90 531.19 17004 201.71 191.62 220.36 # 15820 429.94 408.44 469.71 # 17004 172.98 164.33 188.98 15821 524.52 498.29 573.03 17106 368.48 350.06 402.57 # 15821 459.07 436.12 501.54 # 17106 317.79 301.90 347.19 15822 413.17 392.51 451.39 17107 654.81 622.07 715.38 # 15822 359.30 341.34 392.54 # 17107 584.98 555.73 639.09 15823 596.62 566.79 651.81 17108 888.71 844.27 970.91 # 15823 539.95 512.95 589.89 # 17108 824.46 783.24 900.73 15831 847.50 805.13 925.90 17110 90.84 86.30 99.25 15832 821.27 780.21 897.24 # 17110 54.13 51.42 59.13 15833 775.11 736.35 846.80 17111 103.14 97.98 112.68 15834 765.70 727.42 836.53 # 17111 68.82 65.38 75.19 15835 790.73 751.19 863.87 17250 69.43 65.96 75.85 15836 664.64 631.41 726.12 # 17250 34.32 32.60 37.49 15837 696.10 661.30 760.50 17260 86.92 82.57 94.96 # 15837 649.02 616.57 709.06 # 17260 62.58 59.45 68.37 15838 530.46 503.94 579.53 17261 110.29 104.78 120.50 15839 744.64 707.41 813.52 # 17261 79.16 75.20 86.48 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 7 FSY06 LOCALITY FEE SCHEDULE FOR AREA 99 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 137.39 130.52 150.10 19110 411.41 390.84 449.47 # 17262 102.67 97.54 112.17 # 19110 294.08 279.38 321.29 17263 152.46 144.84 166.57 19112 395.64 375.86 432.24 # 17263 113.75 108.06 124.27 # 19112 260.36 247.34 284.44 17264 165.25 156.99 180.54 19120 413.65 392.97 451.92 # 17264 120.95 114.90 132.14 # 19120 354.59 336.86 387.39 17266 191.97 182.37 209.73 19125 444.26 422.05 485.36 # 17266 140.49 133.47 153.49 # 19125 384.40 365.18 419.96 17270 119.60 113.62 130.66 19126 162.28 154.17 177.30 # 17270 86.48 82.16 94.48 19140 500.67 475.64 546.99 17271 129.56 123.08 141.54 # 19140 350.62 333.09 383.05 # 17271 97.64 92.76 106.67 19160 387.04 367.69 422.84 17272 149.30 141.84 163.12 19162 818.71 777.77 894.44 # 17272 113.79 108.10 124.32 19180 568.96 540.51 621.59 17273 168.65 160.22 184.25 19182 513.46 487.79 560.96 # 17273 128.74 122.30 140.65 19200 962.16 914.05 1,051.16 17274 204.18 193.97 223.07 19220 985.88 936.59 1,077.08 # 17274 159.08 151.13 173.80 19240 996.76 946.92 1,088.96 17276 244.29 232.08 266.89 19260 1,093.79 1,039.10 1,194.97 # 17276 193.61 183.93 211.52 19271 1,511.22 1,435.66 1,651.01 17280 110.29 104.78 120.50 19272 1,661.74 1,578.65 1,815.45 # 17280 78.36 74.44 85.61 19290 164.54 156.31 179.76 17281 143.81 136.62 157.11 # 19290 67.17 63.81 73.38 # 17281 111.08 105.53 121.36 19291 73.44 69.77 80.24 17282 166.27 157.96 181.65 # 19291 33.53 31.85 36.63 # 17282 129.56 123.08 141.54 19295 108.02 102.62 118.01 17283 205.57 195.29 224.58 19296 5,166.72 4,908.38 5,644.64 # 17283 163.27 155.11 178.38 # 19296 209.59 199.11 228.98 17284 243.04 230.89 265.52 19297 95.90 91.11 104.78 # 17284 196.35 186.53 214.51 19298 1,928.15 1,831.74 2,106.50 17286 322.30 306.19 352.12 # 19298 337.49 320.62 368.71 # 17286 273.22 259.56 298.49 19316 753.25 715.59 822.93 17304 627.61 596.23 685.66 19318 1,123.40 1,067.23 1,227.31 # 17304 440.45 418.43 481.19 19324 441.74 419.65 482.60 17305 267.45 254.08 292.19 19325 620.03 589.03 677.38 # 17305 165.29 157.03 180.58 19328 442.39 420.27 483.31 17306 268.25 254.84 293.07 19330 565.71 537.42 618.03 # 17306 165.69 157.41 181.02 19340 395.14 375.38 431.69 17307 254.28 241.57 277.81 19342 834.65 792.92 911.86 # 17307 166.09 157.79 181.46 19350 933.09 886.44 1,019.41 17310 101.74 96.65 111.15 # 19350 666.12 632.81 727.73 # 17310 55.44 52.67 60.57 19355 724.30 688.09 791.30 17340 45.16 42.90 49.34 # 19355 502.02 476.92 548.46 # 17340 44.76 42.52 48.90 19357 1,398.21 1,328.30 1,527.55 17360 113.70 108.02 124.22 19361 1,312.61 1,246.98 1,434.03 # 17360 90.96 86.41 99.37 19364 2,677.35 2,543.48 2,925.00 19000 113.69 108.01 124.21 19366 1,364.27 1,296.06 1,490.47 # 19000 46.65 44.32 50.97 19367 1,760.38 1,672.36 1,923.21 19001 27.12 25.76 29.62 19368 2,145.69 2,038.41 2,344.17 # 19001 22.73 21.59 24.83 19369 1,997.76 1,897.87 2,182.55 19020 401.76 381.67 438.92 19370 618.81 587.87 676.05 # 19020 255.31 242.54 278.92 19371 714.31 678.59 780.38 19030 175.42 166.65 191.65 19380 696.50 661.68 760.93 # 19030 80.84 76.80 88.32 19396 134.25 127.54 146.67 19100 136.32 129.50 148.93 # 19396 130.65 124.12 142.74 # 19100 69.67 66.19 76.12 20000 195.60 185.82 213.69 19101 312.17 296.56 341.04 # 20000 157.29 149.43 171.84 # 19101 208.81 198.37 228.13 20005 282.58 268.45 308.72 19102 233.45 221.78 255.05 # 20005 233.10 221.45 254.67 # 19102 106.55 101.22 116.40 20100 595.91 566.11 651.03 19103 608.87 578.43 665.19 20101 372.15 353.54 406.57 # 19103 198.24 188.33 216.58 # 20101 199.75 189.76 218.22 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 99 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 462.09 438.99 504.84 20692 424.25 403.04 463.50 # 20102 239.81 227.82 261.99 20693 468.36 444.94 511.68 20103 565.91 537.61 618.25 20694 463.83 440.64 506.74 # 20103 358.40 340.48 391.55 # 20694 339.72 322.73 371.14 20150 859.41 816.44 938.91 20802 2,512.37 2,386.75 2,744.76 20200 183.42 174.25 200.39 20805 3,413.09 3,242.44 3,728.81 # 20200 92.04 87.44 100.56 20808 4,229.49 4,018.02 4,620.72 20205 254.48 241.76 278.02 20816 2,816.85 2,676.01 3,077.41 # 20205 146.34 139.02 159.87 20822 2,475.52 2,351.74 2,704.50 20206 299.91 284.91 327.65 20824 2,769.47 2,631.00 3,025.65 # 20206 64.87 61.63 70.87 20827 2,567.79 2,439.40 2,805.31 20220 233.06 221.41 254.62 20838 2,500.64 2,375.61 2,731.95 # 20220 82.21 78.10 89.82 20900 575.89 547.10 629.17 20225 1,055.97 1,003.17 1,153.65 # 20900 465.74 442.45 508.82 # 20225 122.57 116.44 133.91 20902 599.21 569.25 654.64 20240 237.65 225.77 259.64 20910 430.64 409.11 470.48 20245 595.90 566.11 651.03 20912 492.97 468.32 538.57 20250 359.98 341.98 393.28 20920 389.40 369.93 425.42 20251 410.16 389.65 448.10 20922 573.01 544.36 626.01 20500 140.86 133.82 153.89 # 20922 466.06 442.76 509.17 # 20500 111.33 105.76 121.62 20924 511.25 485.69 558.54 20501 146.64 139.31 160.21 20926 424.78 403.54 464.07 # 20501 40.09 38.09 43.80 20931 118.13 112.22 129.05 20520 192.96 183.31 210.81 20937 179.34 170.37 195.93 # 20520 147.07 139.72 160.68 20938 195.28 185.52 213.35 20525 513.29 487.63 560.77 20950 327.40 311.03 357.68 # 20525 252.31 239.69 275.64 # 20950 93.15 88.49 101.76 20526 78.19 74.28 85.42 20955 2,601.23 2,471.17 2,841.85 # 20526 60.24 57.23 65.81 20956 2,681.16 2,547.10 2,929.17 20550 59.46 56.49 64.96 20957 2,502.68 2,377.55 2,734.18 # 20550 40.30 38.29 44.03 20962 2,739.82 2,602.83 2,993.25 20551 57.98 55.08 63.34 20969 2,872.39 2,728.77 3,138.09 # 20551 44.01 41.81 48.08 20970 2,839.95 2,697.95 3,102.64 20552 55.31 52.54 60.42 20972 2,609.22 2,478.76 2,850.57 # 20552 34.56 32.83 37.75 20973 2,904.38 2,759.16 3,173.03 20553 62.46 59.34 68.24 20974 54.25 51.54 59.27 # 20553 38.51 36.58 42.07 # 20974 48.27 45.86 52.74 20600 53.35 50.68 58.28 20975 181.63 172.55 198.43 # 20600 41.38 39.31 45.21 20979 58.09 55.19 63.47 20605 58.50 55.58 63.92 # 20979 39.73 37.74 43.40 # 20605 42.54 40.41 46.47 20982 4,680.69 4,446.66 5,113.66 20610 71.12 67.56 77.69 # 20982 415.53 394.75 453.96 # 20610 49.96 47.46 54.58 21010 700.77 665.73 765.59 20612 57.83 54.94 63.18 21015 421.27 400.21 460.24 # 20612 43.86 41.67 47.92 21025 909.87 864.38 994.04 20615 233.04 221.39 254.60 # 21025 794.14 754.43 867.59 # 20615 166.39 158.07 181.78 21026 515.83 490.04 563.55 20650 188.29 178.88 205.71 # 21026 454.38 431.66 496.41 # 20650 155.57 147.79 169.96 21029 695.08 660.33 759.38 20660 234.29 222.58 255.97 # 21029 600.51 570.48 656.05 # 20660 176.43 167.61 192.75 21030 439.76 417.77 480.44 20661 414.24 393.53 452.56 # 21030 387.48 368.11 423.33 20662 467.90 444.51 511.19 21031 343.69 326.51 375.49 20663 426.10 404.80 465.52 # 21031 281.84 267.75 307.91 20664 637.28 605.42 696.23 21032 350.60 333.07 383.03 20665 141.47 134.40 154.56 # 21032 277.17 263.31 302.81 # 20665 109.14 103.68 119.23 21034 1,301.13 1,236.07 1,421.48 20670 535.89 509.10 585.47 # 21034 1,170.64 1,112.11 1,278.93 # 20670 158.38 150.46 173.03 21040 442.15 420.04 483.05 20680 494.59 469.86 540.34 # 21040 375.11 356.35 409.80 # 20680 291.87 277.28 318.87 21044 858.08 815.18 937.46 20690 250.90 238.36 274.11 21045 1,152.99 1,095.34 1,259.64 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 9 FSY06 LOCALITY FEE SCHEDULE FOR AREA 99 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 1,022.82 971.68 1,117.43 21179 1,491.23 1,416.67 1,629.17 21047 1,311.23 1,245.67 1,432.52 21180 1,671.82 1,588.23 1,826.46 21048 1,048.98 996.53 1,146.01 21181 712.60 676.97 778.52 21049 1,251.13 1,188.57 1,366.86 21182 2,069.33 1,965.86 2,260.74 21050 829.00 787.55 905.68 21183 2,303.43 2,188.26 2,516.50 21060 772.37 733.75 843.81 21184 2,493.33 2,368.66 2,723.96 21070 631.96 600.36 690.41 21188 1,657.96 1,575.06 1,811.32 21076 1,061.10 1,008.05 1,159.26 21193 1,221.70 1,160.62 1,334.71 # 21076 966.92 918.57 1,056.36 21194 1,362.42 1,294.30 1,488.45 21077 2,666.33 2,533.01 2,912.96 21195 1,295.34 1,230.57 1,415.16 # 21077 2,453.23 2,330.57 2,680.16 21196 1,406.14 1,335.83 1,536.20 21079 1,799.29 1,709.33 1,965.73 21198 1,088.03 1,033.63 1,188.67 # 21079 1,625.30 1,544.04 1,775.65 21199 1,013.20 962.54 1,106.92 21080 2,040.35 1,938.33 2,229.08 21206 1,079.89 1,025.90 1,179.79 # 21080 1,835.23 1,743.47 2,004.99 21208 1,313.42 1,247.75 1,434.91 21081 1,853.21 1,760.55 2,024.63 # 21208 803.42 763.25 877.74 # 21081 1,660.86 1,577.82 1,814.49 21209 713.26 677.60 779.24 21082 1,655.88 1,573.09 1,809.05 # 21209 603.91 573.71 659.77 # 21082 1,511.42 1,435.85 1,651.23 21210 1,421.01 1,349.96 1,552.45 21083 1,567.23 1,488.87 1,712.20 # 21210 800.07 760.07 874.08 # 21083 1,392.84 1,323.20 1,521.68 21215 2,128.81 2,022.37 2,325.73 21084 1,816.34 1,725.52 1,984.35 # 21215 827.47 786.10 904.02 # 21084 1,626.79 1,545.45 1,777.27 21230 767.73 729.34 838.74 21085 709.98 674.48 775.65 21235 666.89 633.55 728.58 # 21085 649.72 617.23 709.81 # 21235 529.61 503.13 578.60 21086 2,002.71 1,902.57 2,187.96 21240 1,079.71 1,025.72 1,179.58 # 21086 1,830.32 1,738.80 1,999.62 21242 1,003.41 953.24 1,096.23 21087 1,976.86 1,878.02 2,159.72 21243 1,580.10 1,501.10 1,726.27 # 21087 1,813.24 1,722.58 1,980.97 21244 970.63 922.10 1,060.42 21100 631.42 599.85 689.83 21245 1,061.15 1,008.09 1,159.30 # 21100 359.66 341.68 392.93 # 21245 879.18 835.22 960.50 21110 601.15 571.09 656.75 21246 874.58 830.85 955.48 # 21110 552.86 525.22 604.00 21247 1,635.46 1,553.69 1,786.74 21116 205.77 195.48 224.80 21248 966.06 917.76 1,055.42 # 21116 45.75 43.46 49.98 # 21248 856.72 813.88 935.96 21120 627.83 596.44 685.91 21249 1,405.58 1,335.30 1,535.60 # 21120 504.12 478.91 550.75 # 21249 1,244.36 1,182.14 1,359.46 21121 705.67 670.39 770.95 21255 1,348.73 1,281.29 1,473.48 # 21121 629.05 597.60 687.24 21256 1,131.65 1,075.07 1,236.33 21122 699.28 664.32 763.97 21260 1,167.43 1,109.06 1,275.42 21123 896.21 851.40 979.11 21261 2,264.56 2,151.33 2,474.03 21125 2,636.47 2,504.65 2,880.35 21263 1,919.24 1,823.28 2,096.77 # 21125 759.29 721.33 829.53 21267 1,558.69 1,480.76 1,702.87 21127 2,178.60 2,069.67 2,380.12 21268 1,842.99 1,750.84 2,013.47 # 21127 844.14 801.93 922.22 21270 875.75 831.96 956.75 21137 720.32 684.30 786.95 # 21270 699.76 664.77 764.49 21138 894.28 849.57 977.01 21275 790.45 750.93 863.57 21139 1,032.13 980.52 1,127.60 21280 478.45 454.53 522.71 21141 1,301.20 1,236.14 1,421.56 21282 319.21 303.25 348.74 21142 1,296.00 1,231.20 1,415.88 21295 164.20 155.99 179.39 21143 1,364.85 1,296.61 1,491.10 21296 367.59 349.21 401.59 21145 1,395.00 1,325.25 1,524.04 21300 125.67 119.39 137.30 21146 1,488.40 1,413.98 1,626.08 # 21300 41.46 39.39 45.30 21147 1,482.95 1,408.80 1,620.12 21310 114.91 109.16 125.53 21150 1,703.36 1,618.19 1,860.92 # 21310 29.51 28.03 32.23 21151 2,061.01 1,957.96 2,251.65 21315 230.72 219.18 252.06 21154 2,157.13 2,049.27 2,356.66 # 21315 136.94 130.09 149.60 21155 2,453.40 2,330.73 2,680.34 21320 232.03 220.43 253.49 21159 3,005.94 2,855.64 3,283.99 # 21320 140.25 133.24 153.23 21160 2,983.75 2,834.56 3,259.74 21325 496.89 472.05 542.86 21172 1,708.32 1,622.90 1,866.34 21330 608.78 578.34 665.09 21175 2,110.05 2,004.55 2,305.23 21335 733.85 697.16 801.73 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 99 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 617.88 586.99 675.04 21485 494.88 470.14 540.66 21337 355.84 338.05 388.76 # 21485 472.53 448.90 516.24 # 21337 253.68 241.00 277.15 21490 894.18 849.47 976.89 21338 830.01 788.51 906.79 21495 566.35 538.03 618.73 21339 891.31 846.74 973.75 21497 498.82 473.88 544.96 21340 778.20 739.29 850.18 # 21497 466.50 443.18 509.66 21343 1,153.22 1,095.56 1,259.89 21501 413.96 393.26 452.25 21344 1,479.37 1,405.40 1,616.21 # 21501 309.80 294.31 338.46 21345 730.46 693.94 798.03 21502 523.75 497.56 572.19 # 21345 623.51 592.33 681.18 21510 467.56 444.18 510.81 21346 926.21 879.90 1,011.89 21550 226.32 215.00 247.25 21347 1,172.43 1,113.81 1,280.88 # 21550 151.70 144.12 165.74 21348 1,149.24 1,091.78 1,255.55 21555 401.86 381.77 439.04 21355 402.35 382.23 439.56 # 21555 308.88 293.44 337.46 # 21355 292.21 277.60 319.24 21556 394.26 374.55 430.73 21356 455.70 432.92 497.86 21557 582.80 553.66 636.71 # 21356 352.74 335.10 385.37 21600 519.52 493.54 567.57 21360 504.15 478.94 550.78 21610 996.84 947.00 1,089.05 21365 1,050.10 997.60 1,147.24 21615 683.94 649.74 747.20 21366 1,199.51 1,139.53 1,310.46 21616 831.23 789.67 908.12 21385 707.36 671.99 772.79 21620 525.00 498.75 573.56 21386 659.07 626.12 720.04 21627 540.05 513.05 590.01 21387 758.16 720.25 828.29 21630 1,207.48 1,147.11 1,319.18 21390 722.89 686.75 789.76 21632 1,209.30 1,148.84 1,321.17 21395 884.29 840.08 966.09 21685 923.86 877.67 1,009.32 21400 162.15 154.04 177.15 21700 422.32 401.20 461.38 # 21400 132.62 125.99 144.89 21705 629.18 597.72 687.38 21401 454.61 431.88 496.66 21720 340.23 323.22 371.70 # 21401 274.64 260.91 300.05 21725 517.88 491.99 565.79 21406 530.85 504.31 579.96 21740 1,035.28 983.52 1,131.05 21407 628.87 597.43 687.04 21750 700.15 665.14 764.91 21408 867.26 823.90 947.49 21800 92.61 87.98 101.18 21421 589.57 560.09 644.10 21805 243.60 231.42 266.13 # 21421 548.47 521.05 599.21 21810 486.26 461.95 531.24 21422 667.87 634.48 729.65 21820 126.32 120.00 138.00 21423 804.53 764.30 878.95 # 21820 123.93 117.73 135.39 21431 669.21 635.75 731.11 21825 569.04 540.59 621.68 21432 673.14 639.48 735.40 21920 213.80 203.11 233.58 21433 1,699.58 1,614.60 1,856.79 # 21920 141.17 134.11 154.23 21435 1,220.57 1,159.54 1,333.47 21925 394.35 374.63 430.82 21436 1,883.48 1,789.31 2,057.71 # 21925 317.33 301.46 346.68 21440 397.73 377.84 434.52 21930 437.43 415.56 477.89 # 21440 360.21 342.20 393.53 # 21930 344.85 327.61 376.75 21445 616.88 586.04 673.95 21935 1,137.97 1,081.07 1,243.23 # 21445 561.41 533.34 613.34 22010 825.32 784.05 901.66 21450 417.82 396.93 456.47 22015 818.17 777.26 893.85 # 21450 397.46 377.59 434.23 22100 731.40 694.83 799.05 21451 577.29 548.43 630.69 22101 736.85 700.01 805.01 # 21451 538.98 512.03 588.83 22102 750.38 712.86 819.79 21452 604.24 574.03 660.13 22103 149.81 142.32 163.67 # 21452 267.43 254.06 292.17 22110 928.84 882.40 1,014.76 21453 661.38 628.31 722.56 22112 929.23 882.77 1,015.19 # 21453 660.99 627.94 722.13 22114 931.49 884.92 1,017.66 21454 519.54 493.56 567.59 22116 149.12 141.66 162.91 21461 1,314.47 1,248.75 1,436.06 22210 1,675.18 1,591.42 1,830.13 # 21461 842.39 800.27 920.31 22212 1,379.46 1,310.49 1,507.06 21462 1,513.51 1,437.83 1,653.50 22214 1,402.44 1,332.32 1,532.17 # 21462 917.31 871.44 1,002.16 22216 391.26 371.70 427.46 21465 888.10 843.70 970.26 22220 1,500.07 1,425.07 1,638.83 21470 1,119.97 1,063.97 1,223.57 22222 1,379.92 1,310.92 1,507.56 21480 95.98 91.18 104.86 22224 1,505.29 1,430.03 1,644.53 # 21480 32.53 30.90 35.54 22226 389.67 370.19 425.72 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS06 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 11 FSY06 LOCALITY FEE SCHEDULE FOR AREA 99 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 181.65 172.57 198.46 23020 685.68 651.40 749.11 # 22305 166.09 157.79 181.46 23030 442.05 419.95 482.94 22310 225.63 214.35 246.50 # 23030 262.48 249.36 286.76 # 22310 207.67 197.29 226.88 23031 431.80 410.21 471.74 22315 775.86 737.07 847.63 # 23031 226.29 214.98 247.23 # 22315 681.68 647.60 744.74 23035 699.86 664.87 764.60 22318 1,501.57 1,426.49 1,640.46 23040 709.62 674.14 775.26 22319 1,670.50 1,586.98 1,825.03 23044 563.18 535.02 615.27 22325 1,288.00 1,223.60 1,407.14 23065 191.55 181.97 209.27 22326 1,377.65 1,308.77 1,505.09 # 23065 156.83 148.99 171.34 22327 1,336.98 1,270.13 1,460.65 23066 482.75 458.61 527.40 22328 292.25 277.64 319.29 # 23066 335.10 318.35 366.10 22505 118.88 112.94 129.88 23075 247.11 234.75 269.96 22520 2,854.94 2,712.19 3,119.02 # 23075 172.09 163.49 188.01 # 22520 591.07 561.52 645.75 23076 544.47 517.25 594.84 22521 2,602.27 2,472.16 2,842.98 23077 1,086.64 1,032.31 1,187.16 # 22521 560.28 532.27 612.11 23100 484.90 460.66 529.76 22522 253.92 241.22 277.40 23101 452.73 430.09 494.60 22523 617.14 586.28 674.22 23105 638.07 606.17 697.10 22524 591.55 561.97 646.27 23106 482.83 458.69 527.49 22525 281.57 267.49 307.61 23107 665.68 632.40 727.26 22532 1,627.94 1,546.54 1,778.52 23120 563.72 535.53 615.86 22533 1,512.60 1,436.97 1,652.52 23125 705.46 670.19 770.72 22534 384.63 365.40 420.21 23130 609.19 578.73 665.54 22548 1,771.63 1,683.05 1,935.51 23140 501.67 476.59 548.08 22554 1,327.10 1,260.75 1,449.86 23145 685.61 651.33 749.03 22556 1,603.75 1,523.56 1,752.09 23146 620.46 589.44 677.86 22558 1,468.57 1,395.14 1,604.41 23150 636.85 605.01 695.76 22585 357.12 339.26 390.15 23155 777.44 738.57 849.36 22590 1,447.50 1,375.13 1,581.40 23156 667.84 634.45 729.62 22595 1,374.65 1,305.92 1,501.81 23170 533.56 506.88 582.91 22600 1,166.27 1,107.96 1,274.15 23172 542.41 515.29 592.58 22610 1,164.91 1,106.66 1,272.66 23174 742.79 705.65 811.50 22612 1,492.43 1,417.81 1,630.48 23180 725.93 689.63 793.07 22614 417.81 396.92 456.46 23182 690.70 656.17 754.60 22630 1,469.60 1,396.12 1,605.54 23184 775.59 736.81 847.33 22632 337.98 321.08 369.24 23190 555.44 527.67 606.82 22800 1,310.69 1,245.16 1,431.93 23195 730.49 693.97 798.07 22802 2,131.55 2,024.97 2,328.72 23200 863.03 819.88 942.86 22804 2,484.41 2,360.19 2,714.22 23210 891.96 847.36 974.46 22808 1,790.15 1,700.64 1,955.74 23220 1,056.76 1,003.92 1,154.51 22810 2,030.46 1,928.94 2,218.28 23221 1,229.48 1,168.01 1,343.21 22812 2,195.60 2,085.82 2,398.69 23222 1,652.49 1,569.87 1,805.35 22818 2,147.01 2,039.66 2,345.61 23330 224.52 213.29 245.28 22819 2,403.76 2,283.57 2,626.11 # 23330 152.69 145.06 166.82 22830 795.37 755.60 868.94 23331 588.30 558.89 642.72 22840 814.81 774.07 890.18 23332 871.92 828.32 952.57 22842 815.63 774.85 891.08 23350 178.30 169.39 194.80 22843 856.26 813.45 935.47 # 23350 53.00 50.35 57.90 22844 1,065.34 1,012.07 1,163.88 23395 1,238.08 1,176.18 1,352.61 22845 777.86 738.97 849.82 23397 1,145.57 1,088.29 1,251.53 22846 808.57 768.14 883.36 23400 982.63 933.50 1,073.53 22847 889.88 845.39 972.20 23405 636.27 604.46 695.13 22848 387.84 368.45 423.72 23406 796.57 756.74 870.25 22849 1,282.60 1,218.47 1,401.24 23410 910.68 865.15 994.92 22850 699.34 664.37 764.03 23412 967.22 918.86 1,056.69 22851 431.56 409.98 471.48 23415 747.81 710.42 816.98 22852 667.73 634.34 729.49 23420 1,004.75 954.51 1,097.69 22855 1,060.83 1,007.79 1,158.96 23430 752.58 714.95 822.19 22900 370.97 352.42 405.28 23440 780.16 741.15 852.32 23000 526.09 499.79 574.76 23450 968.94 920.49 1,058.56 # 23000 361.68 343.60 395.14 23455 1,034.62 982.89 1,130.32 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 99 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 1,114.62 1,058.89 1,217.72 # 23931 163.08 154.93 178.17 23462 1,085.26 1,031.00 1,185.65 23935 497.84 472.95 543.89 23465 1,128.13 1,071.72 1,232.48 24000 465.36 442.09 508.40 23466 1,065.18 1,011.92 1,163.71 24006 706.65 671.32 772.02 23470 1,226.57 1,165.24 1,340.03 24065 212.60 201.97 232.27 23472 1,482.40 1,408.28 1,619.52 # 24065 153.94 146.24 168.18 23480 830.96 789.41 907.82 24066 578.23 549.32 631.72 23485 972.36 923.74 1,062.30 # 24066 385.88 366.59 421.58 23490 840.66 798.63 918.42 24075 458.88 435.94 501.33 23491 1,038.46 986.54 1,134.52 # 24075 300.85 285.81 328.68 23500 202.64 192.51 221.39 24076 460.78 437.74 503.40 # 23500 188.67 179.24 206.13 24077 805.48 765.21 879.99 23505 333.77 317.08 364.64 24100 392.15 372.54 428.42 # 23505 311.02 295.47 339.79 24101 499.61 474.63 545.82 23515 580.14 551.13 633.80 24102 617.57 586.69 674.69 23520 206.01 195.71 225.07 24105 329.92 313.42 360.43 # 23520 201.62 191.54 220.27 24110 583.77 554.58 637.77 23525 331.36 314.79 362.01 24115 702.04 666.94 766.98 # 23525 307.41 292.04 335.85 24116 870.03 826.53 950.51 23530 549.36 521.89 600.17 24120 521.00 494.95 569.19 23532 622.58 591.45 680.17 24125 576.79 547.95 630.14 23540 207.69 197.31 226.91 24126 629.91 598.41 688.17 # 23540 187.74 178.35 205.10 24130 508.06 482.66 555.06 23545 301.36 286.29 329.23 24134 770.87 732.33 842.18 # 23545 268.24 254.83 293.05 24136 631.79 600.20 690.23 23550 565.64 537.36 617.96 24138 655.32 622.55 715.93 23552 655.56 622.78 716.20 24140 756.24 718.43 826.19 23570 215.62 204.84 235.57 24145 646.06 613.76 705.82 # 23570 210.83 200.29 230.33 24147 667.47 634.10 729.22 23575 366.09 347.79 399.96 24149 1,071.06 1,017.51 1,170.14 # 23575 343.34 326.17 375.10 24150 969.96 921.46 1,059.68 23585 690.02 655.52 753.85 24151 1,126.28 1,069.97 1,230.47 23600 307.12 291.76 335.52 24152 733.54 696.86 801.39 # 23600 267.22 253.86 291.94 24153 683.27 649.11 746.48 23605 455.03 432.28 497.12 24155 836.23 794.42 913.58 # 23605 413.12 392.46 451.33 24160 610.30 579.79 666.76 23615 755.01 717.26 824.85 24164 497.04 472.19 543.02 23616 1,478.95 1,405.00 1,615.75 24200 209.20 198.74 228.55 23620 247.16 234.80 270.02 # 24200 137.77 130.88 150.51 # 23620 222.02 210.92 242.56 24201 586.32 557.00 640.55 23625 365.74 347.45 399.57 # 24201 362.84 344.70 396.41 # 23625 339.41 322.44 370.81 24220 197.47 187.60 215.74 23630 580.77 551.73 634.49 # 24220 69.77 66.28 76.22 23650 288.17 273.76 314.82 24300 389.45 369.98 425.48 # 23650 247.86 235.47 270.79 24301 761.84 723.75 832.31 23655 360.00 342.00 393.30 24305 584.44 555.22 638.50 23660 576.69 547.86 630.04 24310 477.97 454.07 522.18 23665 403.43 383.26 440.75 24320 751.58 714.00 821.10 # 23665 378.68 359.75 413.71 24330 725.69 689.41 792.82 23670 612.24 581.63 668.87 24331 802.02 761.92 876.21 23675 531.92 505.32 581.12 24332 589.06 559.61 643.55 # 23675 492.01 467.41 537.52 24340 617.84 586.95 674.99 23680 756.20 718.39 826.15 24341 655.74 622.95 716.39 23700 195.39 185.62 213.46 24342 796.71 756.87 870.40 23800 1,021.52 970.44 1,116.01 24343 695.48 660.71 759.82 23802 1,114.78 1,059.04 1,217.90 24344 1,059.99 1,006.99 1,158.04 23900 1,308.26 1,242.85 1,429.28 24345 690.57 656.04 754.45 23920 1,022.20 971.09 1,116.75 24346 1,051.97 999.37 1,149.28 23921 433.92 412.22 474.05 24350 447.61 425.23 489.01 23930 377.15 358.29 412.03 24351 490.54 466.01 535.91 # 23930 216.73 205.89 236.77 24352 522.98 496.83 571.35 23931 312.73 297.09 341.65 24354 522.86 496.72 571.23 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 13 FSY06 LOCALITY FEE SCHEDULE FOR AREA 99 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 537.99 511.09 587.75 24802 1,002.94 952.79 1,095.71 24360 906.22 860.91 990.05 24900 691.02 656.47 754.94 24361 1,020.53 969.50 1,114.93 24920 686.16 651.85 749.63 24362 1,045.38 993.11 1,142.08 24925 544.52 517.29 594.88 24363 1,336.81 1,269.97 1,460.47 24930 726.51 690.18 793.71 24365 647.09 614.74 706.95 24931 766.23 727.92 837.11 24366 691.96 657.36 755.96 24935 973.06 924.41 1,063.07 24400 829.02 787.57 905.71 25000 418.84 397.90 457.59 24410 1,048.83 996.39 1,145.85 25001 313.09 297.44 342.06 24420 994.23 944.52 1,086.20 25020 634.08 602.38 692.74 24430 939.38 892.41 1,026.27 25023 1,148.01 1,090.61 1,254.20 24435 1,000.27 950.26 1,092.80 25024 698.84 663.90 763.49 24470 683.15 648.99 746.34 25025 1,080.07 1,026.07 1,179.98 24495 692.26 657.65 756.30 25028 548.91 521.46 599.68 24498 882.09 837.99 963.69 25031 491.97 467.37 537.48 24500 330.34 313.82 360.89 25035 858.86 815.92 938.31 # 24500 283.65 269.47 309.89 25040 597.69 567.81 652.98 24505 485.82 461.53 530.76 25065 209.01 198.56 228.34 # 24505 437.53 415.65 478.00 # 25065 156.33 148.51 170.79 24515 875.46 831.69 956.44 25066 457.54 434.66 499.86 24516 864.69 821.46 944.68 25075 393.47 373.80 429.87 24530 357.33 339.46 390.38 25076 589.84 560.35 644.40 # 24530 310.64 295.11 339.38 25077 895.19 850.43 977.99 24535 608.24 577.83 664.50 25085 518.06 492.16 565.98 # 24535 559.55 531.57 611.31 25100 375.95 357.15 410.72 24538 753.43 715.76 823.12 25101 435.28 413.52 475.55 24545 786.98 747.63 859.77 25105 540.54 513.51 590.54 24546 1,126.78 1,070.44 1,231.01 25107 606.12 575.81 662.18 24560 298.26 283.35 325.85 25110 448.58 426.15 490.07 # 24560 246.78 234.44 269.61 25111 331.67 315.09 362.35 24565 502.22 477.11 548.68 25112 402.25 382.14 439.46 # 24565 458.72 435.78 501.15 25115 934.08 887.38 1,020.49 24566 659.45 626.48 720.45 25116 827.75 786.36 904.31 24575 793.73 754.04 867.15 25118 415.14 394.38 453.54 24576 312.28 296.67 341.17 25119 560.87 532.83 612.75 # 24576 270.37 256.85 295.38 25120 743.85 706.66 812.66 24577 524.32 498.10 572.82 25125 828.51 787.08 905.14 # 24577 480.82 456.78 525.30 25126 843.80 801.61 921.85 24579 851.61 809.03 930.38 25130 479.57 455.59 523.93 24582 731.76 695.17 799.45 25135 591.39 561.82 646.09 24586 1,102.37 1,047.25 1,204.34 25136 519.84 493.85 567.93 24587 1,088.75 1,034.31 1,189.46 25145 753.24 715.58 822.92 24600 369.28 350.82 403.44 25150 630.29 598.78 688.60 # 24600 315.01 299.26 344.15 25151 823.62 782.44 899.81 24605 445.88 423.59 487.13 25170 1,077.80 1,023.91 1,177.50 24615 716.42 680.60 782.69 25210 522.89 496.75 571.26 24620 545.93 518.63 596.42 25215 684.15 649.94 747.43 24635 1,128.22 1,071.81 1,232.58 25230 466.98 443.63 510.17 24640 122.96 116.81 134.33 25240 497.57 472.69 543.59 # 24640 81.05 77.00 88.55 25246 195.51 185.73 213.59 24650 243.40 231.23 265.91 # 25246 76.99 73.14 84.11 # 24650 202.29 192.18 221.01 25248 556.57 528.74 608.05 24655 425.22 403.96 464.55 25250 523.77 497.58 572.22 # 24655 378.53 359.60 413.54 25251 716.69 680.86 782.99 24665 649.92 617.42 710.03 25259 389.01 369.56 424.99 24666 729.63 693.15 797.12 25260 863.09 819.94 942.93 24670 272.74 259.10 297.97 25263 861.58 818.50 941.28 # 24670 231.23 219.67 252.62 25265 990.15 940.64 1,081.74 24675 442.48 420.36 483.41 25270 736.25 699.44 804.36 # 24675 400.98 380.93 438.07 25272 811.11 770.55 886.13 24685 678.57 644.64 741.34 25274 916.44 870.62 1,001.21 24800 821.92 780.82 897.94 25275 663.68 630.50 725.08 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 99 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 810.76 770.22 885.75 25565 508.48 483.06 555.52 25290 824.07 782.87 900.30 # 25565 457.40 434.53 499.71 25295 763.82 725.63 834.47 25574 588.87 559.43 643.34 25300 708.46 673.04 774.00 25575 829.02 787.57 905.71 25301 678.46 644.54 741.22 25600 275.65 261.87 301.15 25310 865.45 822.18 945.51 # 25600 230.96 219.41 252.32 25312 961.89 913.80 1,050.87 25605 538.44 511.52 588.25 25315 1,008.63 958.20 1,101.93 # 25605 498.14 473.23 544.21 25316 1,167.39 1,109.02 1,275.37 25611 692.12 657.51 756.14 25320 910.70 865.17 994.95 25620 655.87 623.08 716.54 25332 852.65 810.02 931.52 25622 281.79 267.70 307.86 25335 1,007.82 957.43 1,101.04 # 25622 235.10 223.35 256.85 25337 875.43 831.66 956.41 25624 445.81 423.52 487.05 25350 934.33 887.61 1,020.75 # 25624 396.33 376.51 432.99 25355 1,020.03 969.03 1,114.38 25628 672.25 638.64 734.44 25360 915.59 869.81 1,000.28 25630 289.62 275.14 316.41 25365 1,158.31 1,100.39 1,265.45 # 25630 240.13 228.12 262.34 25370 1,215.71 1,154.92 1,328.16 25635 425.55 404.27 464.91 25375 1,216.91 1,156.06 1,329.47 # 25635 343.74 326.55 375.53 25390 1,025.39 974.12 1,120.24 25645 575.01 546.26 628.20 25391 1,243.99 1,181.79 1,359.06 25650 301.29 286.23 329.16 25392 1,228.84 1,167.40 1,342.51 # 25650 255.80 243.01 279.46 25393 1,385.09 1,315.84 1,513.22 25651 447.54 425.16 488.93 25394 762.74 724.60 833.29 25652 603.41 573.24 659.23 25400 1,074.30 1,020.59 1,173.68 25660 385.74 366.45 421.42 25405 1,303.64 1,238.46 1,424.23 25670 617.17 586.31 674.26 25415 1,229.83 1,168.34 1,343.59 25671 502.59 477.46 549.08 25420 1,426.02 1,354.72 1,557.93 25675 421.33 400.26 460.30 25425 1,417.13 1,346.27 1,548.21 # 25675 381.02 361.97 416.27 25426 1,335.97 1,269.17 1,459.55 25676 635.78 603.99 694.59 25430 681.61 647.53 744.66 25680 439.43 417.46 480.08 25431 786.45 747.13 859.20 25685 729.36 692.89 796.82 25440 819.25 778.29 895.03 25690 454.24 431.53 496.26 25441 949.30 901.84 1,037.12 25695 638.30 606.39 697.35 25442 811.37 770.80 886.42 25800 779.64 740.66 851.76 25443 784.98 745.73 857.59 25805 889.95 845.45 972.27 25444 833.80 792.11 910.93 25810 845.28 803.02 923.47 25445 732.12 695.51 799.84 25820 631.88 600.29 690.33 25446 1,176.32 1,117.50 1,285.13 25825 762.09 723.99 832.59 25447 786.09 746.79 858.81 25830 1,002.85 952.71 1,095.62 25449 1,040.60 988.57 1,136.86 25900 882.39 838.27 964.01 25450 745.58 708.30 814.55 25905 878.60 834.67 959.87 25455 823.03 781.88 899.16 25907 798.34 758.42 872.18 25490 952.92 905.27 1,041.06 25909 872.80 829.16 953.53 25491 1,002.80 952.66 1,095.56 25915 1,487.49 1,413.12 1,625.09 25492 1,141.39 1,084.32 1,246.97 25920 682.43 648.31 745.56 25500 246.09 233.79 268.86 25922 596.03 566.23 651.16 # 25500 211.77 201.18 231.36 25924 682.78 648.64 745.94 25505 485.23 460.97 530.12 25927 838.03 796.13 915.55 # 25505 440.54 418.51 481.29 25929 555.99 528.19 607.42 25515 692.62 657.99 756.69 25931 788.14 748.73 861.04 25520 543.07 515.92 593.31 26010 286.45 272.13 312.95 # 25520 511.15 485.59 558.43 # 26010 128.82 122.38 140.74 25525 925.10 878.85 1,010.68 26011 445.51 423.23 486.71 25526 1,095.75 1,040.96 1,197.10 # 26011 185.72 176.43 202.89 25530 239.65 227.67 261.82 26020 412.41 391.79 450.56 # 25530 203.74 193.55 222.58 26025 409.39 388.92 447.26 25535 461.13 438.07 503.78 26030 480.54 456.51 524.99 # 25535 432.40 410.78 472.40 26034 519.63 493.65 567.70 25545 688.25 653.84 751.92 26035 718.24 682.33 784.68 25560 250.49 237.97 273.67 26037 560.69 532.66 612.56 # 25560 206.99 196.64 226.14 26040 303.82 288.63 331.92 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