CALIFORNIA - MEDICARE CARRIER 31140 PAGE 1 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 EFFECTIVE JANUARY 1, 2008-JUNE 30, 2008 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G0101 44.99 42.74 49.15 # G0268 34.70 32.97 37.92 G0102 26.74 25.40 29.21 G0270 30.01 28.51 32.79 # G0102 9.66 9.18 10.56 # G0270 29.44 27.97 32.17 G0104 172.45 163.83 188.40 G0271 16.47 15.65 18.00 # G0104 67.75 64.36 74.01 # G0271 15.90 15.11 17.38 G0105 493.87 469.18 539.56 G0275 15.90 15.11 17.38 # G0105 230.98 219.43 252.34 G0278 15.90 15.11 17.38 G0105 53 172.45 163.83 188.40 G0281 13.48 12.81 14.73 # G0105 53 67.75 64.36 74.01 G0283 13.48 12.81 14.73 G0106 251.88 239.29 275.18 G0288 335.34 318.57 366.36 G0106 TC 197.21 187.35 215.45 G0289 96.91 92.06 105.87 G0106 26 54.67 51.94 59.73 G0308 862.69 819.56 942.49 G0108 40.60 38.57 44.36 G0309 704.29 669.08 769.44 G0109 22.96 21.81 25.08 G0310 548.57 521.14 599.31 G0117 58.44 55.52 63.85 G0311 587.48 558.11 641.83 G0118 41.53 39.45 45.37 G0312 482.14 458.03 526.73 C G0120 246.76 234.42 269.58 G0313 376.80 357.96 411.65 C G0120 TC 192.09 182.49 209.86 G0314 521.36 495.29 569.58 G0120 26 54.67 51.94 59.73 G0315 427.37 406.00 466.90 G0121 493.87 469.18 539.56 G0316 330.30 313.79 360.86 # G0121 230.98 219.43 252.34 G0317 329.77 313.28 360.27 G0121 53 172.45 163.83 188.40 G0318 269.33 255.86 294.24 # G0121 53 67.75 64.36 74.01 G0319 209.29 198.83 228.65 G0124 30.12 28.61 32.90 G0320 662.75 629.61 724.05 G0127 24.46 23.24 26.73 G0321 461.66 438.58 504.37 # G0127 9.66 9.18 10.56 G0322 402.91 382.76 440.17 G0128 4.16 3.95 4.54 G0323 253.40 240.73 276.84 G0130 49.83 47.34 54.44 G0324 24.08 22.88 26.31 G0130 TC 37.99 36.09 41.50 G0325 13.96 13.26 15.25 G0130 26 11.85 11.26 12.95 G0326 16.14 15.33 17.63 G0141 30.12 28.61 32.90 G0327 9.02 8.57 9.86 G0166 232.50 220.88 254.01 G0329 10.75 10.21 11.74 G0168 116.88 111.04 127.70 G0332 112.10 106.50 122.48 # G0168 28.68 27.25 31.34 G0339 3,915.07 3,719.32 4,277.22 G0179 59.21 56.25 64.69 G0340 2,658.17 2,525.26 2,904.05 G0180 76.18 72.37 83.23 G0341 398.79 378.85 435.68 G0181 127.58 121.20 139.38 G0342 747.51 710.13 816.65 G0182 133.27 126.61 145.60 G0343 1,239.28 1,177.32 1,353.92 G0186 368.26 349.85 402.33 G0344 113.33 107.66 123.81 G0202 185.77 176.48 202.95 # G0344 75.20 71.44 82.16 G0202 TC 147.07 139.72 160.68 G0364 14.98 14.23 16.36 G0202 26 38.70 36.77 42.29 # G0364 9.86 9.37 10.78 G0204 209.09 198.64 228.44 C G0365 233.29 221.63 254.87 G0204 TC 160.73 152.69 175.59 C G0365 TC 219.46 208.49 239.76 G0204 26 48.36 45.94 52.83 G0365 26 13.83 13.14 15.11 G0206 166.79 158.45 182.22 G0366 30.55 29.02 33.37 G0206 TC 128.09 121.69 139.94 G0367 20.89 19.85 22.83 G0206 26 38.70 36.77 42.29 G0368 9.66 9.18 10.56 G0237 19.75 18.76 21.57 G0372 18.77 17.83 20.50 G0238 20.89 19.85 22.83 # G0372 9.10 8.65 9.95 G0239 18.61 17.68 20.33 G0389 159.91 151.91 174.70 G0245 77.95 74.05 85.16 G0389 TC 127.36 120.99 139.14 # G0245 48.93 46.48 53.45 G0389 26 32.55 30.92 35.56 G0246 47.83 45.44 52.26 G0392 3,331.44 3,164.87 3,639.60 # G0246 25.07 23.82 27.39 # G0392 546.66 519.33 597.23 G0247 52.29 49.68 57.13 G0393 2,551.69 2,424.11 2,787.73 # G0247 28.39 26.97 31.02 # G0393 351.29 333.73 383.79 G0248 285.28 271.02 311.67 G0396 34.00 32.30 37.15 G0249 209.60 199.12 228.99 # G0396 31.73 30.14 34.66 G0250 10.64 10.11 11.63 G0397 65.93 62.63 72.02 G0268 59.17 56.21 64.64 # G0397 63.08 59.93 68.92 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 2 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G9041 27.31 25.94 29.83 10022 180.50 171.48 197.20 G9042 12.93 12.28 14.12 # 10022 70.11 66.60 76.59 G9043 12.93 12.28 14.12 10040 109.93 104.43 120.09 G9044 11.23 10.67 12.27 # 10040 93.43 88.76 102.07 M0064 48.79 46.35 53.30 10060 122.14 116.03 133.43 # M0064 18.63 17.70 20.36 # 10060 102.23 97.12 111.69 P3001 30.12 28.61 32.90 10061 202.08 191.98 220.78 Q0035 27.70 26.32 30.27 # 10061 176.47 167.65 192.80 Q0035 TC 18.61 17.68 20.33 10080 209.00 198.55 228.33 Q0035 26 9.10 8.65 9.95 # 10080 107.72 102.33 117.68 Q0091 54.11 51.40 59.11 10081 307.83 292.44 336.31 # Q0091 20.54 19.51 22.44 # 10081 176.38 167.56 192.69 Q0092 22.96 21.81 25.08 10120 163.18 155.02 178.27 R0070 191.66 182.08 209.39 # 10120 100.59 95.56 109.89 R0075 191.66 182.08 209.39 10121 302.74 287.60 330.74 0016T 368.26 349.85 402.33 # 10121 200.88 190.84 219.47 0030T 26.31 24.99 28.74 10140 173.60 164.92 189.66 0067T 610.69 580.16 667.18 # 10140 132.06 125.46 144.28 C 0067T TC 271.47 257.90 296.59 10160 143.83 136.64 157.14 0067T 26 72.83 69.19 79.57 # 10160 107.42 102.05 117.36 0073T 890.28 845.77 972.64 10180 265.21 251.95 289.74 0075T 1,304.90 1,239.66 1,425.61 # 10180 195.22 185.46 213.28 0075T 26 904.50 859.28 988.17 11000 59.77 56.78 65.30 0076T 430.62 409.09 470.45 # 11000 33.59 31.91 36.70 0076T 26 90.45 85.93 98.82 11001 24.38 23.16 26.63 0078T 1,605.62 1,525.34 1,754.14 # 11001 16.98 16.13 18.55 0079T 154.58 146.85 168.88 11004 599.00 569.05 654.41 0080T 278.04 264.14 303.76 11005 790.75 751.21 863.89 0081T 27.81 26.42 30.38 11006 741.47 704.40 810.06 0144T 321.60 305.52 351.35 11008 284.15 269.94 310.43 C 0144T TC 143.05 135.90 156.29 11010 551.26 523.70 602.26 0144T 26 60.30 57.29 65.88 # 11010 303.17 288.01 331.21 0145T 477.38 453.51 521.54 11011 622.73 591.59 680.33 0145T TC 402.00 381.90 439.19 # 11011 314.32 298.60 343.39 0145T 26 75.38 71.61 82.35 11012 868.15 824.74 948.45 0146T 633.15 601.49 691.71 # 11012 464.71 441.47 507.69 C 0146T TC 424.02 402.82 463.24 11040 53.09 50.44 58.01 0146T 26 100.50 95.48 109.80 # 11040 29.19 27.73 31.89 0147T 633.15 601.49 691.71 11041 62.64 59.51 68.44 C 0147T TC 424.02 402.82 463.24 # 11041 38.17 36.26 41.70 0147T 26 100.50 95.48 109.80 11042 85.46 81.19 93.37 0148T 633.15 601.49 691.71 # 11042 50.18 47.67 54.82 C 0148T TC 424.02 402.82 463.24 11043 310.25 294.74 338.95 0148T 26 100.50 95.48 109.80 # 11043 262.45 249.33 286.73 0149T 633.15 601.49 691.71 11044 419.22 398.26 458.00 C 0149T TC 424.02 402.82 463.24 # 11044 363.45 345.28 397.07 0149T 26 100.50 95.48 109.80 11055 55.02 52.27 60.11 0150T 633.15 601.49 691.71 # 11055 24.29 23.08 26.54 C 0150T TC 424.02 402.82 463.24 11056 66.43 63.11 72.58 0150T 26 100.50 95.48 109.80 # 11056 33.99 32.29 37.13 0151T 201.00 190.95 219.59 11057 79.17 75.21 86.49 0151T TC 140.70 133.67 153.72 # 11057 44.46 42.24 48.58 0151T 26 60.30 57.29 65.88 11100 118.01 112.11 128.93 0159T 24.88 23.64 27.19 # 11100 50.86 48.32 55.57 0159T TC 21.44 20.37 23.43 11101 35.97 34.17 39.30 0159T 26 3.44 3.27 3.76 # 11101 25.73 24.44 28.11 0171T 881.79 837.70 963.36 11200 93.33 88.66 101.96 0172T 440.89 418.85 481.68 # 11200 76.26 72.45 83.32 0177T 1,576.55 1,497.72 1,722.38 11201 19.99 18.99 21.84 10021 170.65 162.12 186.44 # 11201 17.72 16.83 19.35 # 10021 73.35 69.68 80.13 11300 80.77 76.73 88.24 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 3 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11300 30.70 29.17 33.55 11451 534.39 507.67 583.82 11301 105.59 100.31 115.36 # 11451 320.44 304.42 350.08 # 11301 52.67 50.04 57.55 11462 407.10 386.75 444.76 11302 125.17 118.91 136.75 # 11462 237.53 225.65 259.50 # 11302 64.85 61.61 70.85 11463 545.40 518.13 595.85 11303 148.36 140.94 162.08 # 11463 325.19 308.93 355.27 # 11303 76.09 72.29 83.13 11470 437.76 415.87 478.25 11305 79.83 75.84 87.22 # 11470 277.30 263.44 302.96 # 11305 38.86 36.92 42.46 11471 558.76 530.82 610.44 11306 108.19 102.78 118.20 # 11471 347.08 329.73 379.19 # 11306 59.25 56.29 64.73 11600 211.13 200.57 230.66 11307 126.52 120.19 138.22 # 11600 117.81 111.92 128.71 # 11307 69.05 65.60 75.44 11601 248.89 236.45 271.92 11308 142.52 135.39 155.70 # 11601 151.59 144.01 165.61 # 11308 83.35 79.18 91.06 11602 271.11 257.55 296.18 11310 97.74 92.85 106.78 # 11602 164.70 156.47 179.94 # 11310 44.82 42.58 48.97 11603 304.19 288.98 332.33 11311 119.48 113.51 130.54 # 11603 192.66 183.03 210.48 # 11311 65.42 62.15 71.47 11604 334.57 317.84 365.52 11312 138.98 132.03 151.83 # 11604 209.38 198.91 228.75 # 11312 75.25 71.49 82.21 11606 455.87 433.08 498.04 11313 173.49 164.82 189.54 # 11606 303.37 288.20 331.43 # 11313 100.65 95.62 109.96 11620 213.04 202.39 232.75 11400 142.65 135.52 155.85 # 11620 119.16 113.20 130.18 # 11400 84.04 79.84 91.82 11621 251.00 238.45 274.22 11401 167.00 158.65 182.45 # 11621 153.70 146.02 167.92 # 11401 108.39 102.97 118.42 11622 281.87 267.78 307.95 11402 184.47 175.25 201.54 # 11622 176.04 167.24 192.33 # 11402 117.89 112.00 128.80 11623 324.75 308.51 354.79 11403 208.65 198.22 227.95 # 11623 213.22 202.56 232.94 # 11403 149.48 142.01 163.31 11624 364.79 346.55 398.53 11404 236.21 224.40 258.06 # 11624 241.88 229.79 264.26 # 11404 163.94 155.74 179.10 11626 444.29 422.08 485.39 11406 317.61 301.73 346.99 # 11626 305.45 290.18 333.71 # 11406 236.24 224.43 258.09 11640 222.62 211.49 243.21 11420 139.72 132.73 152.64 # 11640 128.16 121.75 140.01 # 11420 90.22 85.71 98.57 11641 268.11 254.70 292.91 11421 175.60 166.82 191.84 # 11641 167.97 159.57 183.51 # 11421 118.70 112.77 129.69 11642 306.64 291.31 335.01 11422 195.41 185.64 213.49 # 11642 196.25 186.44 214.41 # 11422 143.06 135.91 156.30 11643 354.89 337.15 387.72 11423 225.86 214.57 246.76 # 11643 241.08 229.03 263.38 # 11423 164.40 156.18 179.61 11644 437.56 415.68 478.03 11424 256.58 243.75 280.31 # 11644 299.85 284.86 327.59 # 11424 188.29 178.88 205.71 11646 564.59 536.36 616.81 11426 353.84 336.15 386.57 # 11646 420.62 399.59 459.53 # 11426 278.16 264.25 303.89 11719 24.09 22.89 26.32 11440 157.40 149.53 171.96 # 11719 9.86 9.37 10.78 # 11440 112.45 106.83 122.85 11720 34.86 33.12 38.09 11441 190.13 180.62 207.71 # 11720 17.79 16.90 19.44 # 11441 142.34 135.22 155.50 11721 48.64 46.21 53.14 11442 212.29 201.68 231.93 # 11721 30.44 28.92 33.26 # 11442 156.53 148.70 171.01 11730 109.07 103.62 119.16 11443 251.30 238.74 274.55 # 11730 62.41 59.29 68.18 # 11443 190.42 180.90 208.04 11732 49.45 46.98 54.03 11444 311.61 296.03 340.43 # 11732 31.81 30.22 34.75 # 11444 239.91 227.91 262.10 11740 52.24 49.63 57.07 11446 408.80 388.36 446.61 # 11740 36.30 34.49 39.66 # 11446 332.55 315.92 363.31 11750 235.18 223.42 256.93 11450 407.60 387.22 445.30 # 11750 193.07 183.42 210.93 # 11450 244.86 232.62 267.51 11752 331.30 314.74 361.95 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 4 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11752 294.31 279.59 321.53 12013 198.47 188.55 216.83 11755 151.61 144.03 165.63 # 12013 126.78 120.44 138.51 # 11755 92.43 87.81 100.98 12014 230.81 219.27 252.16 11760 232.35 220.73 253.84 # 12014 150.58 143.05 164.51 # 11760 152.69 145.06 166.82 12015 288.39 273.97 315.07 11762 297.68 282.80 325.22 # 12015 187.10 177.75 204.41 # 11762 224.84 213.60 245.64 12016 338.56 321.63 369.87 11765 153.90 146.21 168.14 # 12016 227.03 215.68 248.03 # 11765 77.09 73.24 84.23 12017 274.51 260.78 299.90 11770 297.64 282.76 325.17 12018 328.58 312.15 358.97 # 11770 186.11 176.80 203.32 12020 313.54 297.86 342.54 11771 576.76 547.92 630.11 # 12020 204.28 194.07 223.18 # 11771 426.54 405.21 465.99 12021 175.66 166.88 191.91 11772 716.89 681.05 783.21 # 12021 148.91 141.46 162.68 # 11772 576.91 548.06 630.27 12031 256.27 243.46 279.98 11900 63.34 60.17 69.20 # 12031 158.40 150.48 173.05 # 11900 32.04 30.44 35.01 12032 349.30 331.84 381.62 11901 76.06 72.26 83.10 # 12032 207.62 197.24 226.83 # 11901 49.89 47.40 54.51 12034 331.39 314.82 362.04 11920 233.93 222.23 255.56 # 12034 207.35 196.98 226.53 # 11920 124.11 117.90 135.59 12035 428.76 407.32 468.42 11921 262.72 249.58 287.02 # 12035 251.23 238.67 274.47 # 11921 146.07 138.77 159.59 12036 467.24 443.88 510.46 11922 77.36 73.49 84.51 # 12036 291.41 276.84 318.37 # 11922 32.40 30.78 35.40 12037 523.09 496.94 571.48 11950 88.52 84.09 96.70 # 12037 338.72 321.78 370.05 # 11950 52.10 49.50 56.93 12041 271.16 257.60 296.24 11951 112.84 107.20 123.28 # 12041 171.02 162.47 186.84 # 11951 69.02 65.57 75.41 12042 322.20 306.09 352.00 11952 162.31 154.19 177.32 # 12042 203.27 193.11 222.08 # 11952 104.27 99.06 113.92 12044 362.79 344.65 396.35 11954 191.39 181.82 209.09 # 12044 218.25 207.34 238.44 # 11954 117.98 112.08 128.89 12045 430.73 409.19 470.57 11960 1,014.39 963.67 1,108.22 # 12045 261.16 248.10 285.32 11970 650.09 617.59 710.23 12046 508.04 482.64 555.04 11971 590.57 561.04 645.20 # 12046 305.46 290.19 333.72 # 11971 343.04 325.89 374.77 12047 542.30 515.19 592.47 11976 165.40 157.13 180.70 # 12047 340.30 323.29 371.78 # 11976 100.53 95.50 109.83 12051 302.31 287.19 330.27 11980 116.49 110.67 127.27 # 12051 188.50 179.08 205.94 # 11980 84.06 79.86 91.84 12052 332.92 316.27 363.71 11981 157.26 149.40 171.81 # 12052 216.84 206.00 236.90 # 11981 90.69 86.16 99.08 12053 362.15 344.04 395.65 11982 179.40 170.43 195.99 # 12053 220.46 209.44 240.86 # 11982 109.98 104.48 120.15 12054 385.49 366.22 421.15 11983 261.96 248.86 286.19 # 12054 234.13 222.42 255.78 # 11983 201.07 191.02 219.67 12055 465.46 442.19 508.52 12001 169.75 161.26 185.45 # 12055 286.78 272.44 313.31 # 12001 106.59 101.26 116.45 12056 577.13 548.27 630.51 12002 179.61 170.63 196.22 # 12056 358.63 340.70 391.81 # 12002 119.87 113.88 130.96 12057 618.85 587.91 676.10 12004 209.66 199.18 229.06 # 12057 413.43 392.76 451.67 # 12004 139.67 132.69 152.59 13100 358.20 340.29 391.33 12005 259.79 246.80 283.82 # 13100 252.93 240.28 276.32 # 12005 172.16 163.55 188.08 13101 446.35 424.03 487.63 12006 321.49 305.42 351.23 # 13101 305.80 290.51 334.09 # 12006 217.36 206.49 237.46 13102 118.27 112.36 129.21 12007 360.11 342.10 393.42 # 13102 77.86 73.97 85.07 # 12007 249.15 236.69 272.19 13120 371.08 352.53 405.41 12011 181.47 172.40 198.26 # 13120 262.96 249.81 287.28 # 12011 110.34 104.82 120.54 13121 488.78 464.34 533.99 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 5 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 13121 343.12 325.96 374.85 15120 1,040.66 988.63 1,136.92 13122 136.17 129.36 148.76 # 15120 846.06 803.76 924.32 # 13122 88.37 83.95 96.54 15121 327.90 311.51 358.24 13131 407.20 386.84 444.87 # 15121 191.33 181.76 209.02 # 13131 298.52 283.59 326.13 15130 789.81 750.32 862.87 13132 629.34 597.87 687.55 # 15130 621.95 590.85 679.48 # 13132 496.19 471.38 542.09 15131 106.38 101.06 116.22 13133 182.17 173.06 199.02 # 15131 89.31 84.84 97.57 # 13133 138.35 131.43 151.14 15135 963.06 914.91 1,052.15 13150 415.46 394.69 453.89 # 15135 844.14 801.93 922.22 # 13150 298.25 283.34 325.84 15136 101.06 96.01 110.41 13151 458.34 435.42 500.73 # 15136 90.82 86.28 99.22 # 13151 345.67 328.39 377.65 15150 794.17 754.46 867.63 13152 619.44 588.47 676.74 # 15150 700.28 665.27 765.06 # 13152 459.55 436.57 502.06 15151 138.62 131.69 151.44 13153 202.74 192.60 221.49 # 15151 119.84 113.85 130.93 # 13153 150.96 143.41 164.92 15152 169.72 161.23 185.41 13160 854.97 812.22 934.05 # 15152 149.80 142.31 163.66 14000 732.20 695.59 799.93 15155 818.41 777.49 894.11 # 14000 581.98 552.88 635.81 # 15155 755.82 718.03 825.73 14001 938.79 891.85 1,025.63 15156 181.64 172.56 198.44 # 14001 771.50 732.93 842.87 # 15156 166.84 158.50 182.28 14020 815.40 774.63 890.82 15157 203.06 192.91 221.85 # 14020 666.89 633.55 728.58 # 15157 182.01 172.91 198.85 14021 1,052.53 999.90 1,149.89 15170 446.64 424.31 487.96 # 14021 895.48 850.71 978.32 # 15170 364.70 346.47 398.44 14040 852.67 810.04 931.55 15171 95.08 90.33 103.88 # 14040 716.11 680.30 782.35 # 15171 89.39 84.92 97.66 14041 1,152.70 1,095.07 1,259.33 15175 582.04 552.94 635.88 # 14041 977.44 928.57 1,067.86 # 15175 503.52 478.34 550.09 14060 861.67 818.59 941.38 15176 153.82 146.13 168.05 # 14060 751.85 714.26 821.40 # 15176 143.57 136.39 156.85 14061 1,253.09 1,190.44 1,369.01 15200 887.95 843.55 970.08 # 14061 1,060.76 1,007.72 1,158.88 # 15200 695.62 660.84 759.97 14300 1,195.94 1,136.14 1,306.56 15201 180.90 171.86 197.64 # 14300 1,024.10 972.90 1,118.84 # 15201 81.32 77.25 88.84 14350 810.68 770.15 885.67 15220 858.51 815.58 937.92 15002 379.42 360.45 414.52 # 15220 679.84 645.85 742.73 # 15002 235.45 223.68 257.23 15221 168.46 160.04 184.05 15003 81.65 77.57 89.21 # 15221 75.71 71.92 82.71 # 15003 45.23 42.97 49.42 15240 1,011.77 961.18 1,105.36 15004 452.65 430.02 494.52 # 15240 858.70 815.77 938.14 # 15004 289.91 275.41 316.72 15241 212.44 201.82 232.09 15005 131.84 125.25 144.04 # 15241 119.69 113.71 130.77 # 15005 91.44 86.87 99.90 15260 1,079.58 1,025.60 1,179.44 15040 317.63 301.75 347.01 # 15260 928.22 881.81 1,014.08 # 15040 137.82 130.93 150.57 15261 244.86 232.62 267.51 15050 615.88 585.09 672.85 # 15261 156.10 148.30 170.55 # 15050 490.12 465.61 535.45 15300 363.70 345.52 397.35 15100 1,007.87 957.48 1,101.10 # 15300 299.40 284.43 327.09 # 15100 784.25 745.04 856.80 15301 64.47 61.25 70.44 15101 242.11 230.00 264.50 # 15301 58.78 55.84 64.22 # 15101 123.18 117.02 134.57 15320 412.53 391.90 450.69 15110 965.16 916.90 1,054.44 # 15320 341.41 324.34 372.99 # 15110 792.75 753.11 866.08 15321 96.71 91.87 105.65 15111 132.41 125.79 144.66 # 15321 88.74 84.30 96.95 # 15111 110.78 105.24 121.03 15330 341.44 324.37 373.03 15115 945.54 898.26 1,033.00 # 15330 275.44 261.67 300.92 # 15115 821.49 780.42 897.48 15331 65.04 61.79 71.06 15116 174.44 165.72 190.58 # 15331 59.92 56.92 65.46 # 15116 151.68 144.10 165.72 15335 364.21 346.00 397.90 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 6 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 15335 297.63 282.75 325.16 15770 710.17 674.66 775.86 15336 95.23 90.47 104.04 15775 353.35 335.68 386.03 # 15336 85.55 81.27 93.46 # 15775 222.48 211.36 243.06 15340 360.22 342.21 393.54 15776 501.62 476.54 548.02 # 15340 295.36 280.59 322.68 # 15776 351.40 333.83 383.90 15341 54.23 51.52 59.25 15780 963.07 914.92 1,052.16 # 15341 28.62 27.19 31.27 # 15780 736.03 699.23 804.11 15360 413.33 392.66 451.56 15781 624.89 593.65 682.70 # 15360 336.52 319.69 367.64 # 15781 494.58 469.85 540.33 15361 74.27 70.56 81.14 15782 690.31 655.79 754.16 # 15361 65.73 62.44 71.81 # 15782 489.45 464.98 534.73 15365 408.09 387.69 445.84 15783 580.36 551.34 634.04 # 15365 338.10 321.20 369.38 # 15783 419.89 398.90 458.74 15366 93.73 89.04 102.40 15786 281.76 267.67 307.82 # 15366 85.19 80.93 93.07 # 15786 148.04 140.64 161.74 15400 421.16 400.10 460.12 15787 67.12 63.76 73.32 # 15400 386.45 367.13 422.20 # 15787 19.33 18.36 21.11 15401 120.81 114.77 131.99 15788 536.76 509.92 586.41 # 15401 60.49 57.47 66.09 # 15788 281.27 267.21 307.29 15420 475.03 451.28 518.97 15789 676.71 642.87 739.30 # 15420 410.73 390.19 448.72 # 15789 480.97 456.92 525.46 15421 128.01 121.61 139.85 15792 526.24 499.93 574.92 # 15421 88.74 84.30 96.95 # 15792 325.95 309.65 356.10 15430 608.42 578.00 664.70 15793 549.02 521.57 599.81 # 15430 584.52 555.29 638.58 # 15793 403.35 383.18 440.66 15570 991.04 941.49 1,082.71 15819 784.84 745.60 857.44 # 15570 753.19 715.53 822.86 15820 604.31 574.09 660.20 15572 925.50 879.23 1,011.11 # 15820 530.34 503.82 579.39 # 15572 750.24 712.73 819.64 15821 641.41 609.34 700.74 15574 1,001.83 951.74 1,094.50 # 15821 558.33 530.41 609.97 # 15574 819.75 778.76 895.57 15822 482.21 458.10 526.82 15576 898.84 853.90 981.99 # 15822 411.65 391.07 449.73 # 15576 726.99 690.64 794.24 15823 732.00 695.40 799.71 15600 442.37 420.25 483.29 # 15823 655.18 622.42 715.78 # 15600 240.37 228.35 262.60 15830 1,217.65 1,156.77 1,330.29 15610 386.44 367.12 422.19 15832 955.43 907.66 1,043.81 # 15610 278.90 264.96 304.70 15833 892.54 847.91 975.10 15620 541.39 514.32 591.47 15834 908.61 863.18 992.66 # 15620 357.03 339.18 390.06 15835 924.36 878.14 1,009.86 15630 548.90 521.46 599.68 15836 784.21 745.00 856.75 # 15630 387.87 368.48 423.75 15837 846.89 804.55 925.23 15650 583.64 554.46 637.63 # 15837 730.81 694.27 798.41 # 15650 418.06 397.16 456.73 15838 626.15 594.84 684.07 15731 1,204.13 1,143.92 1,315.51 15839 920.27 874.26 1,005.40 # 15731 1,058.46 1,005.54 1,156.37 # 15839 756.96 719.11 826.98 15732 1,670.78 1,587.24 1,825.33 15840 1,088.51 1,034.08 1,189.19 # 15732 1,403.34 1,333.17 1,533.15 15841 1,775.44 1,686.67 1,939.67 15734 1,711.67 1,626.09 1,870.00 15842 2,790.46 2,650.94 3,048.58 # 15734 1,439.11 1,367.15 1,572.22 15845 1,017.77 966.88 1,111.91 15736 1,550.45 1,472.93 1,693.87 15851 117.78 111.89 128.67 # 15736 1,242.61 1,180.48 1,357.55 # 15851 47.22 44.86 51.59 15738 1,628.86 1,547.42 1,779.53 15852 48.96 46.51 53.49 # 15738 1,348.90 1,281.46 1,473.68 15860 115.18 109.42 125.83 15740 1,098.48 1,043.56 1,200.09 15920 620.55 589.52 677.95 # 15740 926.64 880.31 1,012.36 15922 800.98 760.93 875.07 15750 989.87 940.38 1,081.44 15931 699.13 664.17 763.80 15756 2,510.94 2,385.39 2,743.20 15933 873.58 829.90 954.39 15757 2,513.85 2,388.16 2,746.38 15934 965.03 916.78 1,054.30 15758 2,502.68 2,377.55 2,734.18 15935 1,150.25 1,092.74 1,256.65 15760 942.78 895.64 1,029.99 15936 943.47 896.30 1,030.75 # 15760 768.09 729.69 839.14 15937 1,108.02 1,052.62 1,210.51 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 7 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 15940 726.06 689.76 793.22 17276 312.36 296.74 341.25 15941 976.76 927.92 1,067.11 # 17276 221.32 210.25 241.79 15944 944.93 897.68 1,032.33 17280 156.59 148.76 171.07 15945 1,044.26 992.05 1,140.86 # 17280 95.70 90.92 104.56 15946 1,707.81 1,622.42 1,865.78 17281 195.13 185.37 213.18 15950 609.80 579.31 666.21 # 17281 131.96 125.36 144.16 15951 867.66 824.28 947.92 17282 225.40 214.13 246.25 15952 896.25 851.44 979.16 # 17282 151.99 144.39 166.05 15953 1,002.10 952.00 1,094.80 17283 270.14 256.63 295.12 15956 1,211.88 1,151.29 1,323.98 # 17283 189.34 179.87 206.85 15958 1,244.07 1,181.87 1,359.15 17284 313.47 297.80 342.47 16000 78.02 74.12 85.24 # 17284 224.70 213.47 245.49 # 16000 47.29 44.93 51.67 17286 393.74 374.05 430.16 16020 98.12 93.21 107.19 # 17286 303.27 288.11 331.33 # 16020 62.27 59.16 68.03 17311 834.45 792.73 911.64 16025 164.58 156.35 179.80 # 17311 398.58 378.65 435.45 # 16025 121.33 115.26 132.55 17312 512.03 486.43 559.39 16030 199.82 189.83 218.30 # 17312 212.16 201.55 231.78 # 16030 139.50 132.53 152.41 17313 764.24 726.03 834.93 16035 221.58 210.50 242.08 # 17313 357.96 340.06 391.07 16036 87.41 83.04 95.50 17314 473.37 449.70 517.16 17000 90.50 85.98 98.88 # 17314 196.26 186.45 214.42 # 17000 59.20 56.24 64.68 17315 96.53 91.70 105.46 17003 8.88 8.44 9.71 # 17315 56.13 53.32 61.32 # 17003 5.47 5.20 5.98 17340 48.51 46.08 52.99 17004 201.60 191.52 220.25 # 17340 49.08 46.63 53.62 # 17004 150.95 143.40 164.91 17360 146.31 138.99 159.84 17106 435.77 413.98 476.08 # 17360 105.91 100.61 115.70 # 17106 359.52 341.54 392.77 19000 142.41 135.29 155.58 17107 742.36 705.24 811.03 # 19000 47.95 45.55 52.38 # 17107 634.81 603.07 693.53 19001 29.95 28.45 32.72 17108 996.41 946.59 1,088.58 # 19001 23.69 22.51 25.89 # 17108 880.33 836.31 961.76 19020 510.44 484.92 557.66 17110 121.53 115.45 132.77 # 19020 304.45 289.23 332.61 # 17110 69.75 66.26 76.20 19030 213.87 203.18 233.66 17111 146.01 138.71 159.52 # 19030 85.84 81.55 93.78 # 17111 89.10 84.65 97.35 19100 166.74 158.40 182.16 17250 91.21 86.65 99.65 # 19100 69.43 65.96 75.85 # 17250 39.43 37.46 43.08 19101 374.20 355.49 408.81 17260 110.12 104.61 120.30 # 19101 226.82 215.48 247.80 # 17260 73.14 69.48 79.90 19102 281.49 267.42 307.53 17261 160.00 152.00 174.80 # 19102 111.92 106.32 122.27 # 17261 97.41 92.54 106.42 19103 751.64 714.06 821.17 17262 192.36 182.74 210.15 # 19103 205.95 195.65 225.00 # 17262 123.51 117.33 134.93 19105 2,783.61 2,644.43 3,041.09 17263 211.20 200.64 230.74 # 19105 194.00 184.30 211.95 # 17263 135.52 128.74 148.05 19110 503.33 478.16 549.88 17264 227.86 216.47 248.94 # 19110 335.47 318.70 366.51 # 17264 144.22 137.01 157.56 19112 491.86 467.27 537.36 17266 256.40 243.58 280.12 # 19112 307.50 292.13 335.95 # 17266 165.36 157.09 180.65 19120 495.64 470.86 541.49 17270 166.38 158.06 181.77 # 19120 404.60 384.37 442.03 # 17270 104.36 99.14 114.01 19125 544.15 516.94 594.48 17271 181.17 172.11 197.93 # 19125 447.41 425.04 488.80 # 17271 117.44 111.57 128.31 19126 161.18 153.12 176.09 17272 206.82 196.48 225.95 19260 1,274.06 1,210.36 1,391.91 # 17272 135.69 128.91 148.25 19271 1,790.76 1,701.22 1,956.40 17273 229.22 217.76 250.42 19272 1,963.20 1,865.04 2,144.80 # 17273 151.83 144.24 165.88 19290 209.89 199.40 229.31 17274 270.60 257.07 295.63 # 19290 71.04 67.49 77.61 # 17274 185.25 175.99 202.39 19291 89.56 85.08 97.84 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 8 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 19291 34.93 33.18 38.16 # 20225 132.41 125.79 144.66 19295 141.89 134.80 155.02 20240 254.48 241.76 278.02 19296 6,153.67 5,845.99 6,722.89 20245 688.14 653.73 751.79 # 19296 213.67 202.99 233.44 20250 406.69 386.36 444.31 19297 95.04 90.29 103.83 20251 452.72 430.08 494.59 19298 2,048.13 1,945.72 2,237.58 20500 149.20 141.74 163.00 # 19298 350.18 332.67 382.57 # 20500 115.05 109.30 125.70 19300 631.01 599.46 689.38 20501 178.05 169.15 194.52 # 19300 405.11 384.85 442.58 # 20501 42.62 40.49 46.56 19301 599.92 569.92 655.41 20520 227.81 216.42 248.88 19302 884.01 839.81 965.78 # 20520 162.37 154.25 177.39 19303 922.23 876.12 1,007.54 20525 597.46 567.59 652.73 19304 574.31 545.59 627.43 # 20525 272.55 258.92 297.76 19305 1,108.03 1,052.63 1,210.52 20526 86.72 82.38 94.74 19306 1,158.25 1,100.34 1,265.39 # 20526 62.26 59.15 68.02 19307 1,163.45 1,105.28 1,271.07 20550 66.55 63.22 72.70 19316 834.29 792.58 911.47 # 20550 43.22 41.06 47.22 19318 1,223.53 1,162.35 1,336.70 20551 65.78 62.49 71.86 19324 519.49 493.52 567.55 # 20551 45.86 43.57 50.11 19325 697.31 662.44 761.81 20552 61.38 58.31 67.06 19328 528.78 502.34 577.69 # 20552 36.91 35.06 40.32 19330 664.72 631.48 726.20 20553 68.96 65.51 75.34 19340 414.33 393.61 452.65 # 20553 41.08 39.03 44.88 19342 985.45 936.18 1,076.61 20555 345.63 328.35 377.60 19350 1,023.12 971.96 1,117.75 20600 62.55 59.42 68.33 # 19350 739.18 702.22 807.55 # 20600 43.77 41.58 47.82 19355 818.14 777.23 893.81 20605 68.48 65.06 74.82 # 19355 582.56 553.43 636.44 # 20605 45.15 42.89 49.32 19357 1,671.90 1,588.31 1,826.56 20610 87.91 83.51 96.04 19361 1,713.42 1,627.75 1,871.91 # 20610 53.77 51.08 58.74 19364 2,932.44 2,785.82 3,203.69 20612 66.84 63.50 73.03 19366 1,447.59 1,375.21 1,581.49 # 20612 46.36 44.04 50.65 19367 1,933.15 1,836.49 2,111.96 20615 262.85 249.71 287.17 19368 2,356.43 2,238.61 2,574.40 # 20615 178.64 169.71 195.17 19369 2,180.67 2,071.64 2,382.39 20650 223.21 212.05 243.86 19370 735.07 698.32 803.07 # 20650 171.43 162.86 187.29 19371 844.28 802.07 922.38 20660 283.53 269.35 309.75 19380 827.32 785.95 903.84 # 20660 241.99 229.89 264.37 19396 242.94 230.79 265.41 20661 517.37 491.50 565.23 # 19396 147.92 140.52 161.60 20662 527.64 501.26 576.45 20000 236.75 224.91 258.65 20663 493.89 469.20 539.58 # 20000 173.59 164.91 189.65 20664 807.94 767.54 882.67 20005 339.17 322.21 370.54 20665 151.14 143.58 165.12 # 20005 256.66 243.83 280.40 # 20665 117.00 111.15 127.82 20100 620.03 589.03 677.38 20670 584.80 555.56 638.89 20101 479.57 455.59 523.93 # 20670 175.67 166.89 191.92 # 20101 212.70 202.07 232.38 20680 702.92 667.77 767.94 20102 560.44 532.42 612.28 # 20680 442.31 420.19 483.22 # 20102 256.59 243.76 280.32 20690 530.27 503.76 579.32 20103 670.39 636.87 732.40 20692 975.71 926.92 1,065.96 # 20103 379.62 360.64 414.74 20693 514.59 488.86 562.19 20150 977.23 928.37 1,067.63 20694 517.96 492.06 565.87 20200 230.76 219.22 252.10 # 20694 378.55 359.62 413.56 # 20200 97.61 92.73 106.64 20802 2,552.00 2,424.40 2,788.06 20205 309.74 294.25 338.39 20805 3,401.97 3,231.87 3,716.65 # 20205 154.97 147.22 169.30 20808 4,432.48 4,210.86 4,842.49 20206 369.94 351.44 404.16 20816 2,759.57 2,621.59 3,014.83 # 20206 70.63 67.10 77.17 20822 2,435.96 2,314.16 2,661.28 20220 253.33 240.66 276.76 20824 2,721.54 2,585.46 2,973.28 # 20220 88.32 83.90 96.49 20827 2,498.97 2,374.02 2,730.12 20225 1,108.28 1,052.87 1,210.80 20838 2,567.50 2,439.13 2,805.00 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 9 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 20900 726.17 689.86 793.34 # 21076 934.24 887.53 1,020.66 # 20900 524.74 498.50 573.28 21077 2,704.76 2,569.52 2,954.95 20902 675.47 641.70 737.96 # 21077 2,365.63 2,247.35 2,584.45 20910 483.90 459.71 528.67 21079 1,865.31 1,772.04 2,037.85 20912 547.27 519.91 597.90 # 21079 1,574.54 1,495.81 1,720.18 20920 449.16 426.70 490.71 21080 2,122.12 2,016.01 2,318.41 20922 686.45 652.13 749.95 # 21080 1,773.31 1,684.64 1,937.34 # 20922 537.36 510.49 587.06 21081 1,938.19 1,841.28 2,117.47 20924 563.75 535.56 615.89 # 21081 1,612.71 1,532.07 1,761.88 20926 482.79 458.65 527.45 21082 1,777.37 1,688.50 1,941.78 20931 118.27 112.36 129.21 # 21082 1,486.03 1,411.73 1,623.49 20937 181.74 172.65 198.55 21083 1,701.74 1,616.65 1,859.15 20938 196.93 187.08 215.14 # 21083 1,374.55 1,305.82 1,501.69 20950 364.01 345.81 397.68 21084 1,960.61 1,862.58 2,141.97 # 20950 102.27 97.16 111.73 # 21084 1,600.99 1,520.94 1,749.08 20955 2,738.38 2,601.46 2,991.68 21085 777.91 739.01 849.86 20956 2,877.62 2,733.74 3,143.80 # 21085 637.93 606.03 696.93 20957 2,636.53 2,504.70 2,880.41 21086 2,001.83 1,901.74 2,187.00 20962 2,886.02 2,741.72 3,152.98 # 21086 1,752.03 1,664.43 1,914.09 20969 3,057.05 2,904.20 3,339.83 21087 1,986.75 1,887.41 2,170.52 20970 3,022.70 2,871.57 3,302.31 # 21087 1,742.64 1,655.51 1,903.84 20972 2,686.56 2,552.23 2,935.06 21088 2,795.68 2,655.90 3,054.29 20973 2,898.06 2,753.16 3,166.13 21100 920.06 874.06 1,005.17 20974 71.62 68.04 78.25 # 21100 461.43 438.36 504.11 # 20974 53.41 50.74 58.35 21110 864.09 820.89 944.02 20975 192.49 182.87 210.30 # 21110 735.49 698.72 803.53 20979 64.39 61.17 70.35 21116 224.44 213.22 245.20 # 20979 39.35 37.38 42.99 # 21116 45.77 43.48 50.00 20982 5,669.11 5,385.65 6,193.50 21120 764.94 726.69 835.69 # 20982 432.99 411.34 473.04 # 21120 591.38 561.81 646.08 20985 154.68 146.95 168.99 21121 871.33 827.76 951.92 21010 790.12 750.61 863.20 # 21121 730.21 693.70 797.76 21015 477.63 453.75 521.81 21122 812.31 771.69 887.44 21025 1,125.29 1,069.03 1,229.38 21123 934.11 887.40 1,020.51 # 21025 934.67 887.94 1,021.13 21125 3,788.03 3,598.63 4,138.42 21026 683.98 649.78 747.25 # 21125 814.90 774.16 890.28 # 21026 557.66 529.78 609.25 21127 4,103.00 3,897.85 4,482.53 21029 850.92 808.37 929.63 # 21127 947.78 900.39 1,035.45 # 21029 697.29 662.43 761.79 21137 817.71 776.82 893.34 21030 566.09 537.79 618.46 21138 979.98 930.98 1,070.63 # 21030 457.98 435.08 500.34 21139 1,066.65 1,013.32 1,165.32 21031 440.61 418.58 481.37 21141 1,457.82 1,384.93 1,592.67 # 21031 327.38 311.01 357.66 21142 1,409.45 1,338.98 1,539.83 21032 450.32 427.80 491.97 21143 1,513.30 1,437.64 1,653.29 # 21032 321.72 305.63 351.47 21145 1,661.62 1,578.54 1,815.32 21034 1,494.43 1,419.71 1,632.67 21146 1,631.34 1,549.77 1,782.24 # 21034 1,292.99 1,228.34 1,412.59 21147 1,800.88 1,710.84 1,967.47 21040 568.37 539.95 620.94 21150 1,925.67 1,829.39 2,103.80 # 21040 447.73 425.34 489.14 21151 2,054.60 1,951.87 2,244.65 21044 967.47 919.10 1,056.97 21154 2,320.25 2,204.24 2,534.88 21045 1,333.51 1,266.83 1,456.85 21155 2,572.93 2,444.28 2,810.92 21046 1,199.13 1,139.17 1,310.05 21159 2,946.77 2,799.43 3,219.34 21047 1,420.06 1,349.06 1,551.42 21160 3,193.96 3,034.26 3,489.40 21048 1,219.05 1,158.10 1,331.82 21172 1,850.78 1,758.24 2,021.98 21049 1,372.94 1,304.29 1,499.93 21175 2,176.05 2,067.25 2,377.34 21050 941.69 894.61 1,028.80 21179 1,578.04 1,499.14 1,724.01 21060 864.78 821.54 944.77 21180 1,781.65 1,692.57 1,946.46 21070 708.22 672.81 773.73 21181 794.69 754.96 868.20 21073 439.75 417.76 480.42 21182 2,187.76 2,078.37 2,390.13 # 21073 258.24 245.33 282.13 21183 2,492.76 2,368.12 2,723.34 21076 1,095.84 1,041.05 1,197.21 21184 2,550.71 2,423.17 2,786.65 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 10 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21188 1,832.71 1,741.07 2,002.23 21344 1,649.15 1,566.69 1,801.69 21193 1,346.74 1,279.40 1,471.31 21345 912.13 866.52 996.50 21194 1,542.69 1,465.56 1,685.39 # 21345 724.36 688.14 791.36 21195 1,497.39 1,422.52 1,635.90 21346 1,080.67 1,026.64 1,180.64 21196 1,615.57 1,534.79 1,765.01 21347 1,299.10 1,234.15 1,419.27 21198 1,278.50 1,214.58 1,396.77 21348 1,295.93 1,231.13 1,415.80 21199 1,093.47 1,038.80 1,194.62 21355 505.48 480.21 552.24 21206 1,242.10 1,180.00 1,357.00 # 21355 351.84 334.25 384.39 21208 1,997.52 1,897.64 2,182.29 21356 577.36 548.49 630.76 # 21208 918.66 872.73 1,003.64 # 21356 420.88 399.84 459.82 21209 941.43 894.36 1,028.51 21360 587.13 557.77 641.44 # 21209 726.91 690.56 794.14 21365 1,188.23 1,128.82 1,298.14 21210 2,376.48 2,257.66 2,596.31 21366 1,326.48 1,260.16 1,449.18 # 21210 914.67 868.94 999.28 21385 794.13 754.42 867.58 21215 4,097.43 3,892.56 4,476.44 21386 727.56 691.18 794.86 # 21215 947.90 900.51 1,035.59 21387 844.15 801.94 922.23 21230 847.17 804.81 925.53 21390 832.93 791.28 909.97 21235 839.85 797.86 917.54 21395 1,042.43 990.31 1,138.86 # 21235 630.45 598.93 688.77 21400 205.59 195.31 224.61 21240 1,217.01 1,156.16 1,329.58 # 21400 163.48 155.31 178.61 21242 1,128.86 1,072.42 1,233.28 21401 562.16 534.05 614.16 21243 1,817.83 1,726.94 1,985.98 # 21401 320.33 304.31 349.96 21244 1,171.38 1,112.81 1,279.73 21406 598.15 568.24 653.48 21245 1,295.50 1,230.73 1,415.34 21407 699.06 664.11 763.73 # 21245 1,007.00 956.65 1,100.15 21408 943.87 896.68 1,031.18 21246 949.68 902.20 1,037.53 21421 840.96 798.91 918.75 21247 1,766.41 1,678.09 1,929.80 # 21421 719.19 683.23 785.71 21248 1,180.79 1,121.75 1,290.01 21422 756.15 718.34 826.09 # 21248 957.73 909.84 1,046.32 21423 882.06 837.96 963.65 21249 1,633.44 1,551.77 1,784.54 21431 868.93 825.48 949.30 # 21249 1,344.37 1,277.15 1,468.72 21432 750.55 713.02 819.97 21255 1,551.24 1,473.68 1,694.73 21433 1,796.54 1,706.71 1,962.72 21256 1,257.63 1,194.75 1,373.96 21435 1,428.09 1,356.69 1,560.19 21260 1,381.78 1,312.69 1,509.59 21436 2,020.93 1,919.88 2,207.86 21261 2,378.24 2,259.33 2,598.23 21440 612.97 582.32 669.67 21263 2,086.59 1,982.26 2,279.60 # 21440 511.68 486.10 559.02 21267 1,780.36 1,691.34 1,945.04 21445 857.26 814.40 936.56 21268 1,973.53 1,874.85 2,156.08 # 21445 709.32 673.85 774.93 21270 1,037.17 985.31 1,133.11 21450 642.13 610.02 701.52 # 21270 762.33 724.21 832.84 # 21450 548.24 520.83 598.95 21275 875.54 831.76 956.52 21451 842.22 800.11 920.13 21280 583.51 554.33 637.48 # 21451 721.02 684.97 787.72 21282 397.03 377.18 433.76 21452 800.43 760.41 874.47 21295 203.17 193.01 221.96 # 21452 390.74 371.20 426.88 21296 466.77 443.43 509.94 21453 969.52 921.04 1,059.20 21310 143.34 136.17 156.60 # 21453 879.61 835.63 960.97 # 21310 28.97 27.52 31.65 21454 612.35 581.73 668.99 21315 321.05 305.00 350.75 21461 2,225.36 2,114.09 2,431.20 # 21315 170.26 161.75 186.01 # 21461 1,066.83 1,013.49 1,165.51 21320 303.62 288.44 331.71 21462 2,417.59 2,296.71 2,641.22 # 21320 154.54 146.81 168.83 # 21462 1,151.52 1,093.94 1,258.03 21325 594.44 564.72 649.43 21465 997.85 947.96 1,090.15 21330 706.23 670.92 771.56 21470 1,283.35 1,219.18 1,402.06 21335 846.41 804.09 924.70 21480 116.87 111.03 127.68 21336 764.23 726.02 834.92 # 21480 33.22 31.56 36.29 21337 470.75 447.21 514.29 21485 750.89 713.35 820.35 # 21337 324.51 308.28 354.52 # 21485 650.17 617.66 710.31 21338 938.10 891.20 1,024.88 21490 997.80 947.91 1,090.10 21339 992.73 943.09 1,084.55 21495 779.67 740.69 851.79 21340 871.12 827.56 951.69 21497 756.49 718.67 826.47 21343 1,335.40 1,268.63 1,458.92 # 21497 651.79 619.20 712.08 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 11 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21501 515.45 489.68 563.13 22310 306.12 290.81 334.43 # 21501 354.98 337.23 387.81 # 22310 279.37 265.40 305.21 21502 573.42 544.75 626.46 22315 946.45 899.13 1,034.00 21510 529.58 503.10 578.57 # 22315 809.89 769.40 884.81 21550 302.92 287.77 330.94 22318 1,665.31 1,582.04 1,819.35 # 21550 176.60 167.77 192.94 22319 1,816.35 1,725.53 1,984.36 21555 488.81 464.37 534.03 22325 1,464.36 1,391.14 1,599.81 # 21555 355.66 337.88 388.56 22326 1,525.90 1,449.61 1,667.05 21556 447.52 425.14 488.91 22327 1,512.08 1,436.48 1,651.95 21557 619.36 588.39 676.65 22328 296.56 281.73 323.99 21600 606.41 576.09 662.50 22505 131.80 125.21 143.99 21610 1,127.40 1,071.03 1,231.68 22520 3,363.08 3,194.93 3,674.17 21615 732.71 696.07 800.48 # 22520 635.76 603.97 694.57 21616 896.43 851.61 979.35 22521 3,211.50 3,050.93 3,508.57 21620 579.71 550.72 633.33 # 22521 601.98 571.88 657.66 21627 612.77 582.13 669.45 22522 259.77 246.78 283.80 21630 1,358.69 1,290.76 1,484.37 22523 662.58 629.45 723.87 21632 1,330.61 1,264.08 1,453.69 22524 635.82 604.03 694.63 21685 1,083.19 1,029.03 1,183.38 22525 288.01 273.61 314.65 21700 479.35 455.38 523.69 22526 2,898.06 2,753.16 3,166.13 21705 660.74 627.70 721.86 # 22526 355.68 337.90 388.59 21720 408.72 388.28 446.52 22527 2,418.15 2,297.24 2,641.83 21725 577.91 549.01 631.36 # 22527 159.14 151.18 173.86 21740 1,143.52 1,086.34 1,249.29 22532 1,818.21 1,727.30 1,986.40 21750 761.07 723.02 831.47 22533 1,710.65 1,625.12 1,868.89 21800 113.31 107.64 123.79 22534 388.96 369.51 424.94 # 21800 115.02 109.27 125.66 22548 1,941.44 1,844.37 2,121.03 21805 291.60 277.02 318.57 22554 1,366.89 1,298.55 1,493.33 21810 558.65 530.72 610.33 22556 1,745.25 1,657.99 1,906.69 21820 153.72 146.03 167.93 22558 1,595.65 1,515.87 1,743.25 21825 629.24 597.78 687.45 22585 359.34 341.37 392.58 21920 296.26 281.45 323.67 22590 1,613.58 1,532.90 1,762.84 # 21920 172.21 163.60 188.14 22595 1,539.86 1,462.87 1,682.30 21925 472.66 449.03 516.38 22600 1,323.09 1,256.94 1,445.48 # 21925 361.13 343.07 394.53 22610 1,310.09 1,244.59 1,431.28 21930 527.70 501.32 576.52 22612 1,680.24 1,596.23 1,835.66 # 21930 397.39 377.52 434.15 22614 420.95 399.90 459.89 21935 1,217.09 1,156.24 1,329.68 22630 1,616.68 1,535.85 1,766.23 22010 971.85 923.26 1,061.75 22632 341.36 324.29 372.93 22015 965.71 917.42 1,055.03 22800 1,442.12 1,370.01 1,575.51 22100 874.27 830.56 955.14 22802 2,269.85 2,156.36 2,479.81 22101 876.47 832.65 957.55 22804 2,627.15 2,495.79 2,870.16 22102 880.42 836.40 961.86 22808 1,933.14 1,836.48 2,111.95 22103 151.65 144.07 165.68 22810 2,161.63 2,053.55 2,361.58 22110 1,066.21 1,012.90 1,164.84 22812 2,379.56 2,260.58 2,599.67 22112 1,064.39 1,011.17 1,162.85 22818 2,353.69 2,236.01 2,571.41 22114 1,065.45 1,012.18 1,164.01 22819 2,653.07 2,520.42 2,898.48 22116 150.91 143.36 164.86 22830 868.69 825.26 949.05 22206 2,447.77 2,325.38 2,674.19 22840 821.71 780.62 897.71 22207 2,419.99 2,298.99 2,643.84 22842 822.68 781.55 898.78 22208 596.96 567.11 652.18 22843 869.44 825.97 949.87 22210 1,854.94 1,762.19 2,026.52 22844 1,078.46 1,024.54 1,178.22 22212 1,547.16 1,469.80 1,690.27 22845 781.65 742.57 853.96 22214 1,566.21 1,487.90 1,711.09 22846 812.71 772.07 887.88 22216 395.36 375.59 431.93 22847 897.03 852.18 980.01 22220 1,675.82 1,592.03 1,830.83 22848 392.65 373.02 428.97 22222 1,508.40 1,432.98 1,647.93 22849 1,378.82 1,309.88 1,506.36 22224 1,667.22 1,583.86 1,821.44 22850 768.38 729.96 839.45 22226 393.08 373.43 429.44 22851 435.68 413.90 475.99 22305 208.52 198.09 227.80 22852 737.29 700.43 805.49 # 22305 187.46 178.09 204.80 22855 1,167.35 1,108.98 1,275.33 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 12 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 22857 1,870.93 1,777.38 2,043.99 23412 1,041.49 989.42 1,137.83 22862 2,174.88 2,066.14 2,376.06 23415 808.24 767.83 883.00 22865 2,119.89 2,013.90 2,315.99 23420 1,155.37 1,097.60 1,262.24 22900 425.76 404.47 465.14 23430 815.17 774.41 890.57 23000 636.88 605.04 695.80 23440 838.46 796.54 916.02 # 23000 401.88 381.79 439.06 23450 1,042.33 990.21 1,138.74 23020 758.62 720.69 828.79 23455 1,107.33 1,051.96 1,209.75 23030 522.84 496.70 571.21 23460 1,200.58 1,140.55 1,311.63 # 23030 284.42 270.20 310.73 23462 1,170.75 1,112.21 1,279.04 23031 516.35 490.53 564.11 23465 1,217.81 1,156.92 1,330.46 # 23031 247.78 235.39 270.70 23466 1,209.94 1,149.44 1,321.86 23035 769.31 730.84 840.47 23470 1,327.06 1,260.71 1,449.82 23040 790.04 750.54 863.12 23472 1,627.39 1,546.02 1,777.92 23044 630.92 599.37 689.28 23480 902.32 857.20 985.78 23065 239.85 227.86 262.04 23485 1,051.50 998.93 1,148.77 # 23065 180.67 171.64 197.39 23490 896.84 852.00 979.80 23066 601.54 571.46 657.18 23491 1,114.01 1,058.31 1,217.06 # 23066 378.49 359.57 413.51 23500 238.89 226.95 260.99 23075 301.72 286.63 329.62 # 23500 230.92 219.37 252.28 # 23075 191.90 182.31 209.66 23505 384.48 365.26 420.05 23076 608.07 577.67 664.32 # 23505 357.16 339.30 390.20 23077 1,253.47 1,190.80 1,369.42 23515 749.84 712.35 819.20 23100 540.31 513.29 590.28 23520 245.36 233.09 268.05 23101 500.39 475.37 546.68 # 23520 244.22 232.01 266.81 23105 701.43 666.36 766.31 23525 387.02 367.67 422.82 23106 532.34 505.72 581.58 # 23525 355.15 337.39 388.00 23107 729.47 693.00 796.95 23530 605.60 575.32 661.62 23120 621.27 590.21 678.74 23532 684.69 650.46 748.03 23125 767.63 729.25 838.64 23540 244.50 232.28 267.12 23130 673.21 639.55 735.48 # 23540 231.98 220.38 253.44 23140 558.99 531.04 610.70 23545 350.69 333.16 383.13 23145 755.99 718.19 825.92 # 23545 313.13 297.47 342.09 23146 680.79 646.75 743.76 23550 629.98 598.48 688.25 23150 713.61 677.93 779.62 23552 724.57 688.34 791.59 23155 860.28 817.27 939.86 23570 253.30 240.64 276.74 23156 738.71 701.77 807.04 # 23570 253.87 241.18 277.36 23170 588.06 558.66 642.46 23575 427.95 406.55 467.53 23172 611.67 581.09 668.25 # 23575 397.22 377.36 433.96 23174 826.90 785.56 903.39 23585 990.36 940.84 1,081.97 23180 782.37 743.25 854.74 23600 361.35 343.28 394.77 23182 754.53 716.80 824.32 # 23600 320.95 304.90 350.64 23184 841.17 799.11 918.98 23605 520.61 494.58 568.77 23190 611.42 580.85 667.98 # 23605 468.26 444.85 511.58 23195 815.16 774.40 890.56 23615 943.64 896.46 1,030.93 23200 940.06 893.06 1,027.02 23616 1,420.17 1,349.16 1,551.53 23210 986.69 937.36 1,077.96 23620 295.26 280.50 322.58 23220 1,164.06 1,105.86 1,271.74 # 23620 270.23 256.72 295.23 23221 1,350.71 1,283.17 1,475.65 23625 421.87 400.78 460.90 23222 1,811.68 1,721.10 1,979.27 # 23625 388.29 368.88 424.21 23330 271.65 258.07 296.78 23630 792.81 753.17 866.15 # 23330 168.09 159.69 183.64 23650 329.09 312.64 359.54 23331 651.67 619.09 711.95 # 23650 286.98 272.63 313.52 23332 967.27 918.91 1,056.75 23655 415.50 394.73 453.94 23350 213.09 202.44 232.81 23660 637.75 605.86 696.74 # 23350 56.04 53.24 61.23 23665 465.19 441.93 508.22 23395 1,393.78 1,324.09 1,522.70 # 23665 431.05 409.50 470.93 23397 1,241.15 1,179.09 1,355.95 23670 877.55 833.67 958.72 23400 1,063.47 1,010.30 1,161.85 23675 606.76 576.42 662.88 23405 693.64 658.96 757.80 # 23675 550.43 522.91 601.35 23406 859.03 816.08 938.49 23680 961.57 913.49 1,050.51 23410 981.35 932.28 1,072.12 23700 215.24 204.48 235.15 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 13 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 23800 1,114.11 1,058.40 1,217.16 24342 862.09 818.99 941.84 23802 1,308.49 1,243.07 1,429.53 24343 778.84 739.90 850.89 23900 1,424.26 1,353.05 1,556.01 24344 1,190.21 1,130.70 1,300.31 23920 1,164.12 1,105.91 1,271.80 24345 773.92 735.22 845.50 23921 497.68 472.80 543.72 24346 1,186.77 1,127.43 1,296.54 23930 435.38 413.61 475.65 24357 499.24 474.28 545.42 # 23930 236.23 224.42 258.08 24358 579.81 550.82 633.44 23931 362.22 344.11 395.73 24359 695.65 660.87 760.00 # 23931 181.27 172.21 198.04 24360 978.93 929.98 1,069.48 23935 557.21 529.35 608.75 24361 1,101.12 1,046.06 1,202.97 24000 521.06 495.01 569.26 24362 1,040.51 988.48 1,136.75 24006 780.24 741.23 852.41 24363 1,595.60 1,515.82 1,743.19 24065 287.42 273.05 314.01 24365 705.33 670.06 770.57 # 24065 182.15 173.04 199.00 24366 753.51 715.83 823.20 24066 692.70 658.07 756.78 24400 901.41 856.34 984.79 # 24066 432.09 410.49 472.06 24410 1,139.39 1,082.42 1,244.78 24075 565.66 537.38 617.99 24420 1,068.35 1,014.93 1,167.17 # 24075 341.47 324.40 373.06 24430 1,119.71 1,063.72 1,223.28 24076 513.48 487.81 560.98 24435 1,158.15 1,100.24 1,265.28 24077 874.36 830.64 955.24 24470 723.32 687.15 790.22 24100 439.34 417.37 479.98 24495 749.80 712.31 819.16 24101 552.85 525.21 603.99 24498 955.41 907.64 1,043.79 24102 677.00 643.15 739.62 24500 391.58 372.00 427.80 24105 382.06 362.96 417.40 # 24500 340.37 323.35 371.85 24110 641.15 609.09 700.45 24505 558.10 530.20 609.73 24115 717.32 681.45 783.67 # 24505 496.65 471.82 542.59 24116 948.07 900.67 1,035.77 24515 961.98 913.88 1,050.96 24120 576.22 547.41 629.52 24516 946.26 898.95 1,033.79 24125 651.96 619.36 712.26 24530 420.87 399.83 459.80 24126 696.34 661.52 760.75 # 24530 366.81 348.47 400.74 24130 562.61 534.48 614.65 24535 687.98 653.58 751.62 24134 839.81 797.82 917.49 # 24535 625.96 594.66 683.86 24136 691.95 657.35 755.95 24538 827.26 785.90 903.79 24138 729.18 692.72 796.63 24545 974.35 925.63 1,064.47 24140 811.14 770.58 886.17 24546 1,159.56 1,101.58 1,266.82 24145 688.29 653.88 751.96 24560 355.54 337.76 388.42 24147 722.46 686.34 789.29 # 24560 299.21 284.25 326.89 24149 1,249.87 1,187.38 1,365.49 24565 576.44 547.62 629.76 24150 1,059.45 1,006.48 1,157.45 # 24565 520.10 494.10 568.22 24151 1,226.95 1,165.60 1,340.44 24566 766.28 727.97 837.17 24152 788.93 749.48 861.90 24575 813.44 772.77 888.69 24153 728.50 692.08 795.89 24576 374.86 356.12 409.54 24155 913.88 868.19 998.42 # 24576 324.79 308.55 354.83 24160 668.26 634.85 730.08 24577 596.85 567.01 652.06 24164 549.56 522.08 600.39 # 24577 538.81 511.87 588.65 24200 242.59 230.46 265.03 24579 912.50 866.88 996.91 # 24200 152.12 144.51 166.19 24582 873.16 829.50 953.93 24201 679.49 645.52 742.35 24586 1,193.44 1,133.77 1,303.84 # 24201 402.94 382.79 440.21 24587 1,185.18 1,125.92 1,294.81 24220 227.23 215.87 248.25 24600 410.17 389.66 448.11 # 24220 73.59 69.91 80.40 # 24600 354.97 337.22 387.80 24300 459.70 436.72 502.23 24605 505.52 480.24 552.28 24301 824.81 783.57 901.11 24615 786.44 747.12 859.19 24305 641.87 609.78 701.25 24620 606.73 576.39 662.85 24310 527.02 500.67 575.77 24635 939.48 892.51 1,026.39 24320 830.67 789.14 907.51 24640 141.73 134.64 154.84 24330 788.81 749.37 861.78 # 24640 91.65 87.07 100.13 24331 865.42 822.15 945.47 24650 290.51 275.98 317.38 24332 661.85 628.76 723.07 # 24650 248.97 236.52 272.00 24340 678.14 644.23 740.86 24655 490.29 465.78 535.65 24341 794.85 755.11 868.38 # 24655 435.09 413.34 475.34 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 14 FSY08 LOCALITY FEE SCHEDULE FOR AREA 05 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 24665 719.15 683.19 785.67 25250 580.36 551.34 634.04 24666 805.86 765.57 880.41 25251 786.79 747.45 859.57 24670 323.63 307.45 353.57 25259 459.10 436.15 501.57 # 24670 277.54 263.66 303.21 25260 864.65 821.42 944.63 24675 510.21 484.70 557.41 25263 855.18 812.42 934.28 # 24675 457.86 434.97 500.22 25265 992.60 942.97 1,084.42 24685 721.52 685.44 788.26 25270 718.08 682.18 784.51 24800 877.74 833.85 958.93 25272 794.41 754.69 867.89 24802 1,075.52 1,021.74 1,175.00 25274 909.66 864.18 993.81 24900 770.72 732.18 842.01 25275 739.66 702.68 808.08 24920 757.30 719.44 827.36 25280 797.99 758.09 871.80 24925 592.25 562.64 647.04 25290 760.79 722.75 831.16 24930 796.79 756.95 870.49 25295 751.53 713.95 821.04 24931 818.45 777.53 894.16 25300 770.83 732.29 842.13 24935 1,148.01 1,090.61 1,254.20 25301 732.45 695.83 800.20 25000 442.21 420.10 483.12 25310 857.47 814.60 936.79 25001 374.43 355.71 409.07 25312 960.50 912.48 1,049.35 25020 700.80 665.76 765.62 25315 1,019.03 968.08 1,113.29 25023 1,274.99 1,211.24 1,392.93 25316 1,172.95 1,114.30 1,281.45 25024 818.62 777.69 894.34 25320 1,076.76 1,022.92 1,176.36 25025 1,227.81 1,166.42 1,341.38 25332 926.65 880.32 1,012.37 25028 613.14 582.48 669.85 25335 1,075.54 1,021.76 1,175.02 25031 485.96 461.66 530.91 25337 999.47 949.50 1,091.93 25035 839.49 797.52 917.15 25350 926.58 880.25 1,012.29 25040 647.75 615.36 707.66 25355 1,012.44 961.82 1,106.09 25065 289.49 275.02 316.27 25360 906.82 861.48 990.70 # 25065 184.79 175.55 201.88 25365 1,175.30 1,116.54 1,284.02 25066 471.37 447.80 514.97 25370 1,254.90 1,192.16 1,370.98 25075 407.08 386.73 444.74 25375 1,227.41 1,166.04 1,340.95 25076 580.13 551.12 633.79 25390 1,025.22 973.96 1,120.05 25077 900.25 855.24 983.53 25391 1,264.74 1,201.50 1,381.73 25085 548.28 520.87 599.00 25392 1,263.18 1,200.02 1,380.02 25100 409.55 389.07 447.43 25393 1,411.45 1,340.88 1,542.01 25101 474.56 450.83 518.45 25394 839.54 797.56 917.19 25105 577.55 548.67 630.97 25400 1,072.16 1,018.55 1,171.33 25107 700.85 665.81 765.68 25405 1,320.64 1,254.61 1,442.80 25109 559.40 531.43 611.14 25415 1,249.27 1,186.81 1,364.83 25110 457.04 434.19 499.32 25420 1,455.14 1,382.38 1,589.74 25111 369.54 351.06 403.72 25425 1,374.38 1,305.66 1,501.51 25112 442.30 420.19 483.22 25426 1,363.18 1,295.02 1,489.27 25115 985.84 936.55 1,077.03 25430 774.58 735.85 846.23 25116 834.65 792.92 911.86 25431 862.93 819.78 942.75 25118 452.19 429.58 494.02 25440 871.51 827.93 952.12 25119 596.02 566.22 651.15