1HNPRDS08 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 1 FSY08 LOCALITY FEE SCHEDULE FOR AREA 06 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 45.02 42.77 49.19 # G0268 34.89 33.15 38.12 G0102 26.69 25.36 29.16 G0270 30.08 28.58 32.87 # G0102 9.71 9.22 10.60 # G0270 29.52 28.04 32.25 G0104 172.09 163.49 188.01 G0271 16.53 15.70 18.06 # G0104 67.95 64.55 74.23 # G0271 15.97 15.17 17.45 G0105 493.39 468.72 539.03 G0275 15.97 15.17 17.45 # G0105 231.91 220.31 253.36 G0278 15.97 15.17 17.45 G0105 53 172.09 163.49 188.01 G0281 13.52 12.84 14.77 # G0105 53 67.95 64.55 74.23 G0283 13.52 12.84 14.77 G0106 251.06 238.51 274.29 G0288 333.46 316.79 364.31 G0106 TC 196.09 186.29 214.23 G0289 97.18 92.32 106.17 G0106 26 54.98 52.23 60.06 G0308 865.84 822.55 945.93 G0108 40.38 38.36 44.11 G0309 706.98 671.63 772.37 G0109 22.83 21.69 24.94 G0310 550.81 523.27 601.76 G0117 58.41 55.49 63.81 G0311 590.26 560.75 644.86 G0118 41.41 39.34 45.24 G0312 484.49 460.27 529.31 C G0120 245.97 233.67 268.72 G0313 378.74 359.80 413.77 C G0120 TC 190.99 181.44 208.66 G0314 523.62 497.44 572.06 G0120 26 54.98 52.23 60.06 G0315 429.29 407.83 469.00 G0121 493.39 468.72 539.03 G0316 331.91 315.31 362.61 # G0121 231.91 220.31 253.36 G0317 331.11 314.55 361.73 G0121 53 172.09 163.49 188.01 G0318 270.47 256.95 295.49 # G0121 53 67.95 64.55 74.23 G0319 210.24 199.73 229.69 G0124 30.21 28.70 33.01 G0320 665.66 632.38 727.24 G0127 24.43 23.21 26.69 G0321 464.12 440.91 507.05 # G0127 9.71 9.22 10.60 G0322 404.96 384.71 442.42 G0128 4.18 3.97 4.57 G0323 254.62 241.89 278.17 G0130 49.67 47.19 54.27 G0324 24.17 22.96 26.40 G0130 TC 37.76 35.87 41.25 G0325 14.02 13.32 15.32 G0130 26 11.91 11.31 13.01 G0326 16.22 15.41 17.72 G0141 30.21 28.70 33.01 G0327 9.06 8.61 9.90 G0166 231.30 219.74 252.70 G0329 10.73 10.19 11.72 G0168 116.53 110.70 127.31 G0332 111.50 105.93 121.82 # G0168 28.80 27.36 31.46 G0339 3,915.07 3,719.32 4,277.22 G0179 59.17 56.21 64.64 G0340 2,658.17 2,525.26 2,904.05 G0180 76.18 72.37 83.23 G0341 400.78 380.74 437.85 G0181 127.94 121.54 139.77 G0342 750.24 712.73 819.64 G0182 133.60 126.92 145.96 G0343 1,244.04 1,181.84 1,359.12 G0186 368.26 349.85 402.33 G0344 113.51 107.83 124.00 G0202 185.16 175.90 202.29 # G0344 75.59 71.81 82.58 G0202 TC 146.25 138.94 159.78 G0364 14.98 14.23 16.36 G0202 26 38.91 36.96 42.50 # G0364 9.89 9.40 10.81 G0204 208.46 198.04 227.75 C G0365 232.09 220.49 253.56 G0204 TC 159.83 151.84 174.62 C G0365 TC 218.19 207.28 238.37 G0204 26 48.63 46.20 53.13 G0365 26 13.90 13.21 15.19 G0206 166.29 157.98 181.68 G0366 30.48 28.96 33.30 G0206 TC 127.38 121.01 139.16 G0367 20.76 19.72 22.68 G0206 26 38.91 36.96 42.50 G0368 9.71 9.22 10.60 G0237 19.63 18.65 21.45 G0372 18.77 17.83 20.50 G0238 20.76 19.72 22.68 # G0372 9.15 8.69 9.99 G0239 18.50 17.58 20.22 G0389 159.36 151.39 174.10 G0245 78.06 74.16 85.28 G0389 TC 126.63 120.30 138.35 # G0245 49.19 46.73 53.74 G0389 26 32.73 31.09 35.75 G0246 47.85 45.46 52.28 G0392 3,319.23 3,153.27 3,626.26 # G0246 25.21 23.95 27.54 # G0392 549.36 521.89 600.17 G0247 52.31 49.69 57.14 G0393 2,541.63 2,414.55 2,776.73 # G0247 28.54 27.11 31.18 # G0393 353.02 335.37 385.68 G0248 283.75 269.56 309.99 G0396 34.22 32.51 37.39 G0249 208.47 198.05 227.76 # G0396 31.96 30.36 34.91 G0250 10.69 10.16 11.68 G0397 66.37 63.05 72.51 G0268 59.22 56.26 64.70 # G0397 63.54 60.36 69.41 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 06 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 27.44 26.07 29.98 10022 180.29 171.28 196.97 G9042 12.92 12.27 14.11 # 10022 70.49 66.97 77.02 G9043 12.92 12.27 14.11 10040 110.06 104.56 120.24 G9044 11.23 10.67 12.27 # 10040 93.65 88.97 102.32 M0064 48.76 46.32 53.27 10060 122.17 116.06 133.47 # M0064 18.76 17.82 20.49 # 10060 102.36 97.24 111.83 P3001 30.21 28.70 33.01 10061 202.38 192.26 221.10 Q0035 27.65 26.27 30.21 # 10061 176.91 168.06 193.27 Q0035 TC 18.50 17.58 20.22 10080 208.57 198.14 227.86 Q0035 26 9.15 8.69 9.99 # 10080 107.83 102.44 117.81 Q0091 54.05 51.35 59.05 10081 307.61 292.23 336.06 # Q0091 20.65 19.62 22.56 # 10081 176.87 168.03 193.23 Q0092 22.83 21.69 24.94 10120 163.02 154.87 178.10 R0070 191.66 182.08 209.39 # 10120 100.76 95.72 110.08 R0075 191.66 182.08 209.39 10121 302.65 287.52 330.65 0016T 368.26 349.85 402.33 # 10121 201.34 191.27 219.96 0030T 26.31 24.99 28.74 10140 173.54 164.86 189.59 0067T 604.09 573.89 659.97 # 10140 132.23 125.62 144.46 C 0067T TC 269.82 256.33 294.78 10160 143.75 136.56 157.04 0067T 26 72.41 68.79 79.11 # 10160 107.53 102.15 117.47 0073T 885.44 841.17 967.35 10180 265.04 251.79 289.56 0075T 1,296.38 1,231.56 1,416.29 # 10180 195.43 185.66 213.51 0075T 26 904.50 859.28 988.17 11000 59.79 56.80 65.32 0076T 427.81 406.42 467.38 # 11000 33.75 32.06 36.87 0076T 26 90.45 85.93 98.82 11001 24.41 23.19 26.67 0078T 1,595.36 1,515.59 1,742.93 # 11001 17.05 16.20 18.63 0079T 153.57 145.89 167.77 11004 602.22 572.11 657.93 0080T 276.36 262.54 301.92 11005 794.96 755.21 868.49 0081T 27.64 26.26 30.20 11006 745.06 707.81 813.98 0144T 321.60 305.52 351.35 11008 285.45 271.18 311.86 C 0144T TC 142.18 135.07 155.33 11010 550.61 523.08 601.54 0144T 26 60.30 57.29 65.88 # 11010 303.84 288.65 331.95 0145T 477.38 453.51 521.54 11011 622.12 591.01 679.66 0145T TC 402.00 381.90 439.19 # 11011 315.36 299.59 344.53 0145T 26 75.38 71.61 82.35 11012 867.22 823.86 947.44 0146T 633.15 601.49 691.71 # 11012 465.94 442.64 509.04 C 0146T TC 421.44 400.37 460.43 11040 53.09 50.44 58.01 0146T 26 100.50 95.48 109.80 # 11040 29.32 27.85 32.03 0147T 633.15 601.49 691.71 11041 62.63 59.50 68.43 C 0147T TC 421.44 400.37 460.43 # 11041 38.30 36.39 41.85 0147T 26 100.50 95.48 109.80 11042 85.44 81.17 93.35 0148T 633.15 601.49 691.71 # 11042 50.35 47.83 55.00 C 0148T TC 421.44 400.37 460.43 11043 310.33 294.81 339.03 0148T 26 100.50 95.48 109.80 # 11043 262.79 249.65 287.10 0149T 633.15 601.49 691.71 11044 419.33 398.36 458.11 C 0149T TC 421.44 400.37 460.43 # 11044 363.87 345.68 397.53 0149T 26 100.50 95.48 109.80 11055 54.97 52.22 60.05 0150T 633.15 601.49 691.71 # 11055 24.41 23.19 26.67 C 0150T TC 421.44 400.37 460.43 11056 66.42 63.10 72.57 0150T 26 100.50 95.48 109.80 # 11056 34.16 32.45 37.32 0151T 201.00 190.95 219.59 11057 79.20 75.24 86.53 0151T TC 140.70 133.67 153.72 # 11057 44.67 42.44 48.81 0151T 26 60.30 57.29 65.88 11100 117.86 111.97 128.77 0159T 24.79 23.55 27.08 # 11100 51.08 48.53 55.81 0159T TC 21.35 20.28 23.32 11101 36.03 34.23 39.36 0159T 26 3.46 3.29 3.78 # 11101 25.84 24.55 28.23 0171T 884.56 840.33 966.38 11200 93.31 88.64 101.94 0172T 442.28 420.17 483.20 # 11200 76.33 72.51 83.39 0177T 1,580.31 1,501.29 1,726.48 11201 20.06 19.06 21.92 10021 170.49 161.97 186.27 # 11201 17.80 16.91 19.45 # 10021 73.71 70.02 80.52 11300 80.65 76.62 88.11 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 06 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 30.84 29.30 33.70 11451 533.99 507.29 583.38 11301 105.54 100.26 115.30 # 11451 321.18 305.12 350.89 # 11301 52.91 50.26 57.80 11462 406.58 386.25 444.19 11302 125.13 118.87 136.70 # 11462 237.92 226.02 259.92 # 11302 65.13 61.87 71.15 11463 544.94 517.69 595.34 11303 148.30 140.89 162.02 # 11463 325.90 309.61 356.05 # 11303 76.43 72.61 83.50 11470 437.51 415.63 477.97 11305 79.78 75.79 87.16 # 11470 277.90 264.01 303.61 # 11305 39.03 37.08 42.64 11471 558.49 530.57 610.16 11306 108.19 102.78 118.20 # 11471 347.95 330.55 380.13 # 11306 59.52 56.54 65.02 11600 210.94 200.39 230.45 11307 126.52 120.19 138.22 # 11600 118.12 112.21 129.04 # 11307 69.36 65.89 75.77 11601 248.76 236.32 271.77 11308 142.58 135.45 155.77 # 11601 151.98 144.38 166.04 # 11308 83.72 79.53 91.46 11602 270.98 257.43 296.04 11310 97.65 92.77 106.69 # 11602 165.15 156.89 180.42 # 11310 45.02 42.77 49.19 11603 304.22 289.01 332.36 11311 119.47 113.50 130.53 # 11603 193.29 183.63 211.17 # 11311 65.70 62.42 71.78 11604 334.63 317.90 365.59 11312 138.96 132.01 151.81 # 11604 210.12 199.61 229.55 # 11312 75.57 71.79 82.56 11606 456.36 433.54 498.57 11313 173.52 164.84 189.57 # 11606 304.68 289.45 332.87 # 11313 101.08 96.03 110.43 11620 212.85 202.21 232.54 11400 142.40 135.28 155.57 # 11620 119.47 113.50 130.53 # 11400 84.11 79.90 91.89 11621 250.87 238.33 274.08 11401 166.84 158.50 182.28 # 11621 154.09 146.39 168.35 # 11401 108.55 103.12 118.59 11622 281.77 267.68 307.83 11402 184.30 175.09 201.35 # 11622 176.50 167.68 192.83 # 11402 118.08 112.18 129.01 11623 324.82 308.58 354.87 11403 208.58 198.15 227.87 # 11623 213.89 203.20 233.68 # 11403 149.72 142.23 163.56 11624 364.93 346.68 398.68 11404 236.14 224.33 257.98 # 11624 242.68 230.55 265.13 # 11404 164.26 156.05 179.46 11626 444.54 422.31 485.66 11406 317.92 302.02 347.32 # 11626 306.44 291.12 334.79 # 11406 236.99 225.14 258.91 11640 222.39 211.27 242.96 11420 139.55 132.57 152.46 # 11640 128.44 122.02 140.32 # 11420 90.31 85.79 98.66 11641 267.93 254.53 292.71 11421 175.50 166.73 191.74 # 11641 168.32 159.90 183.89 # 11421 118.90 112.96 129.90 11642 306.51 291.18 334.86 11422 195.31 185.54 213.37 # 11642 196.71 186.87 214.90 # 11422 143.24 136.08 156.49 11643 354.97 337.22 387.80 11423 225.82 214.53 246.71 # 11643 241.77 229.68 264.13 # 11423 164.70 156.47 179.94 11644 437.72 415.83 478.20 11424 256.61 243.78 280.35 # 11644 300.75 285.71 328.57 # 11424 188.70 179.27 206.16 11646 565.15 536.89 617.42 11426 354.25 336.54 387.02 # 11646 421.96 400.86 460.99 # 11426 278.98 265.03 304.78 11719 24.06 22.86 26.29 11440 157.15 149.29 171.68 # 11719 9.91 9.41 10.82 # 11440 112.44 106.82 122.84 11720 34.85 33.11 38.08 11441 189.99 180.49 207.56 # 11720 17.87 16.98 19.53 # 11441 142.45 135.33 155.63 11721 48.69 46.26 53.20 11442 212.16 201.55 231.78 # 11721 30.58 29.05 33.41 # 11442 156.70 148.87 171.20 11730 109.11 103.65 119.20 11443 251.29 238.73 274.54 # 11730 62.70 59.57 68.51 # 11443 190.73 181.19 208.37 11732 49.51 47.03 54.08 11444 311.76 296.17 340.60 # 11732 31.96 30.36 34.91 # 11444 240.45 228.43 262.69 11740 52.17 49.56 56.99 11446 409.37 388.90 447.24 # 11740 36.32 34.50 39.68 # 11446 333.53 316.85 364.38 11750 235.31 223.54 257.07 11450 407.22 386.86 444.89 # 11750 193.43 183.76 211.32 # 11450 245.35 233.08 268.04 11752 331.52 314.94 362.18 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 06 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 294.74 280.00 322.00 12013 198.58 188.65 216.95 11755 151.55 143.97 165.57 # 12013 127.27 120.91 139.05 # 11755 92.69 88.06 101.27 12014 231.01 219.46 252.38 11760 232.01 220.41 253.47 # 12014 151.20 143.64 165.19 # 11760 152.77 145.13 166.90 12015 288.71 274.27 315.41 11762 297.72 282.83 325.25 # 12015 187.96 178.56 205.34 # 11762 225.28 214.02 246.12 12016 339.03 322.08 370.39 11765 153.49 145.82 167.69 # 12016 228.10 216.70 249.21 # 11765 77.08 73.23 84.21 12017 275.76 261.97 301.27 11770 297.53 282.65 325.05 12018 329.97 313.47 360.49 # 11770 186.60 177.27 203.86 12020 313.36 297.69 342.34 11771 577.05 548.20 630.43 # 12020 204.69 194.46 223.63 # 11771 427.63 406.25 467.19 12021 175.76 166.97 192.02 11772 717.13 681.27 783.46 # 12021 149.16 141.70 162.96 # 11772 577.90 549.01 631.36 12031 256.17 243.36 279.86 11900 63.32 60.15 69.17 # 12031 158.82 150.88 173.51 # 11900 32.19 30.58 35.17 12032 348.91 331.46 381.18 11901 76.14 72.33 83.18 # 12032 207.98 197.58 227.22 # 11901 50.10 47.60 54.74 12034 331.33 314.76 361.97 11920 233.56 221.88 255.16 # 12034 207.95 197.55 227.18 # 11920 124.33 118.11 135.83 12035 428.42 407.00 468.05 11921 262.38 249.26 286.65 # 12035 251.84 239.25 275.14 # 11921 146.36 139.04 159.90 12036 467.01 443.66 510.21 11922 77.21 73.35 84.35 # 12036 292.12 277.51 319.14 # 11922 32.50 30.88 35.51 12037 522.88 496.74 571.25 11950 88.54 84.11 96.73 # 12037 339.51 322.53 370.91 # 11950 52.32 49.70 57.16 12041 271.11 257.55 296.18 11951 112.92 107.27 123.36 # 12041 171.50 162.93 187.37 # 11951 69.34 65.87 75.75 12042 322.11 306.00 351.90 11952 162.42 154.30 177.45 # 12042 203.83 193.64 222.69 # 11952 104.69 99.46 114.38 12044 362.68 344.55 396.23 11954 191.39 181.82 209.09 # 12044 218.93 207.98 239.18 # 11954 118.38 112.46 129.33 12045 430.50 408.98 470.33 11960 1,015.20 964.44 1,109.11 # 12045 261.84 248.75 286.06 11970 651.01 618.46 711.23 12046 507.71 482.32 554.67 11971 589.26 559.80 643.77 # 12046 306.22 290.91 334.55 # 11971 343.06 325.91 374.80 12047 542.02 514.92 592.16 11976 165.53 157.25 180.84 # 12047 341.10 324.05 372.66 # 11976 101.01 95.96 110.35 12051 302.14 287.03 330.08 11980 116.73 110.89 127.52 # 12051 188.95 179.50 206.43 # 11980 84.47 80.25 92.29 12052 332.80 316.16 363.58 11981 157.28 149.42 171.83 # 12052 217.34 206.47 237.44 # 11981 91.07 86.52 99.50 12053 362.06 343.96 395.55 11982 179.47 170.50 196.08 # 12053 221.14 210.08 241.59 # 11982 110.42 104.90 120.64 12054 385.45 366.18 421.11 11983 262.51 249.38 286.79 # 12054 234.90 223.16 256.63 # 11983 201.95 191.85 220.63 12055 465.52 442.24 508.58 12001 169.84 161.35 185.55 # 12055 287.80 273.41 314.42 # 12001 107.01 101.66 116.91 12056 577.03 548.18 630.41 12002 179.75 170.76 196.37 # 12056 359.70 341.72 392.98 # 12002 120.32 114.30 131.45 12057 618.99 588.04 676.25 12004 209.84 199.35 229.25 # 12057 414.67 393.94 453.03 # 12004 140.23 133.22 153.20 13100 358.12 340.21 391.24 12005 260.07 247.07 284.13 # 13100 253.41 240.74 276.85 # 12005 172.91 164.26 188.90 13101 446.29 423.98 487.58 12006 321.89 305.80 351.67 # 13101 306.49 291.17 334.85 # 12006 218.32 207.40 238.51 13102 118.34 112.42 129.28 12007 360.54 342.51 393.89 # 13102 78.16 74.25 85.39 # 12007 250.18 237.67 273.32 13120 371.04 352.49 405.36 12011 181.54 172.46 198.33 # 13120 263.50 250.33 287.88 # 12011 110.79 105.25 121.04 13121 488.77 464.33 533.98 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 06 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 343.88 326.69 375.69 15120 1,041.37 989.30 1,137.70 13122 136.27 129.46 148.88 # 15120 847.81 805.42 926.23 # 13122 88.73 84.29 96.93 15121 327.63 311.25 357.94 13131 407.27 386.91 444.95 # 15121 191.80 182.21 209.54 # 13131 299.17 284.21 326.84 15130 789.74 750.25 862.79 13132 629.87 598.38 688.14 # 15130 622.78 591.64 680.39 # 13132 497.43 472.56 543.44 15131 106.65 101.32 116.52 13133 182.47 173.35 199.35 # 15131 89.67 85.19 97.97 # 13133 138.89 131.95 151.74 15135 964.12 915.91 1,053.30 13150 415.46 394.69 453.89 # 15135 845.83 803.54 924.07 # 13150 298.87 283.93 326.52 15136 101.36 96.29 110.73 13151 458.52 435.59 500.93 # 15136 91.17 86.61 99.60 # 13151 346.46 329.14 378.51 15150 795.16 755.40 868.71 13152 619.89 588.90 677.24 # 15150 701.78 666.69 766.69 # 13152 460.85 437.81 503.48 15151 138.99 132.04 151.85 13153 203.03 192.88 221.81 # 15151 120.31 114.29 131.43 # 13153 151.53 143.95 165.54 15152 170.20 161.69 185.94 13160 857.04 814.19 936.32 # 15152 150.39 142.87 164.30 14000 732.26 695.65 800.00 15155 819.80 778.81 895.63 # 14000 582.84 553.70 636.76 # 15155 757.54 719.66 827.61 14001 939.36 892.39 1,026.25 15156 182.21 173.10 199.07 # 14001 772.96 734.31 844.46 # 15156 167.49 159.12 182.99 14020 815.52 774.74 890.95 15157 203.66 193.48 222.50 # 14020 667.80 634.41 729.57 # 15157 182.72 173.58 199.62 14021 1,053.49 1,000.82 1,150.94 15170 447.71 425.32 489.12 # 14021 897.28 852.42 980.28 # 15170 366.21 347.90 400.09 14040 853.08 810.43 931.99 15171 95.44 90.67 104.27 # 14040 717.25 681.39 783.60 # 15171 89.78 85.29 98.08 14041 1,154.10 1,096.40 1,260.86 15175 583.52 554.34 637.49 # 14041 979.78 930.79 1,070.41 # 15175 505.42 480.15 552.17 14060 862.39 819.27 942.16 15176 154.38 146.66 168.66 # 14060 753.16 715.50 822.83 # 15176 144.20 136.99 157.54 14061 1,254.56 1,191.83 1,370.60 15200 888.32 843.90 970.49 # 14061 1,063.26 1,010.10 1,161.62 # 15200 697.02 662.17 761.50 14300 1,197.26 1,137.40 1,308.01 15201 180.66 171.63 197.37 # 14300 1,026.34 975.02 1,121.27 # 15201 81.62 77.54 89.17 14350 812.44 771.82 887.59 15220 858.47 815.55 937.88 15002 379.42 360.45 414.52 # 15220 680.76 646.72 743.73 # 15002 236.23 224.42 258.08 15221 168.23 159.82 183.79 15003 81.65 77.57 89.21 # 15221 75.98 72.18 83.01 # 15003 45.43 43.16 49.63 15240 1,012.25 961.64 1,105.89 15004 452.78 430.14 494.66 # 15240 860.00 817.00 939.55 # 15004 290.91 276.36 317.81 15241 212.35 201.73 231.99 15005 132.02 125.42 144.23 # 15241 120.10 114.10 131.22 # 15005 91.84 87.25 100.34 15260 1,080.58 1,026.55 1,180.53 15040 317.06 301.21 346.39 # 15260 930.03 883.53 1,016.06 # 15040 138.21 131.30 151.00 15261 244.84 232.60 267.49 15050 615.66 584.88 672.61 # 15261 156.55 148.72 171.03 # 15050 490.58 466.05 535.96 15300 364.41 346.19 398.12 15100 1,007.94 957.54 1,101.17 # 15300 300.46 285.44 328.26 # 15100 785.51 746.23 858.16 15301 64.68 61.45 70.67 15101 241.77 229.68 264.13 # 15301 59.02 56.07 64.48 # 15101 123.48 117.31 134.91 15320 413.39 392.72 451.63 15110 966.15 917.84 1,055.52 # 15320 342.64 325.51 374.34 # 15110 794.66 754.93 868.17 15321 97.03 92.18 106.01 15111 132.73 126.09 145.00 # 15321 89.10 84.65 97.35 # 15111 111.22 105.66 121.51 15330 341.86 324.77 373.49 15115 946.90 899.56 1,034.49 # 15330 276.21 262.40 301.76 # 15115 823.52 782.34 899.69 15331 65.25 61.99 71.29 15116 174.90 166.16 191.08 # 15331 60.16 57.15 65.72 # 15116 152.27 144.66 166.36 15335 364.80 346.56 398.54 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 6 FSY08 LOCALITY FEE SCHEDULE FOR AREA 06 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 298.58 283.65 326.20 15770 711.31 675.74 777.10 15336 95.51 90.73 104.34 15775 353.67 335.99 386.39 # 15336 85.89 81.60 93.84 # 15775 223.50 212.33 244.18 15340 360.44 342.42 393.78 15776 502.04 476.94 548.48 # 15340 295.92 281.12 323.29 # 15776 352.62 334.99 385.24 15341 54.22 51.51 59.24 15780 962.90 914.76 1,051.97 # 15341 28.75 27.31 31.41 # 15780 737.08 700.23 805.26 15360 413.37 392.70 451.61 15781 624.45 593.23 682.21 # 15360 336.96 320.11 368.13 # 15781 494.84 470.10 540.62 15361 74.52 70.79 81.41 15782 689.18 654.72 752.93 # 15361 66.03 62.73 72.14 # 15782 489.39 464.92 534.66 15365 408.31 387.89 446.07 15783 579.82 550.83 633.45 # 15365 338.69 321.76 370.02 # 15783 420.21 399.20 459.08 15366 94.05 89.35 102.75 15786 281.49 267.42 307.53 # 15366 85.56 81.28 93.47 # 15786 148.48 141.06 162.22 15400 421.42 400.35 460.40 15787 66.95 63.60 73.14 # 15400 386.89 367.55 422.68 # 15787 19.41 18.44 21.21 15401 120.72 114.68 131.88 15788 535.13 508.37 584.63 # 15401 60.72 57.68 66.33 # 15788 281.01 266.96 307.00 15420 475.29 451.53 519.26 15789 676.06 642.26 738.60 # 15420 411.33 390.76 449.37 # 15789 481.36 457.29 525.88 15421 128.15 121.74 140.00 15792 524.53 498.30 573.05 # 15421 89.10 84.65 97.35 # 15792 325.30 309.04 355.40 15430 608.55 578.12 664.84 15793 548.38 520.96 599.10 # 15430 584.78 555.54 638.87 # 15793 403.49 383.32 440.82 15570 991.33 941.76 1,083.02 15819 786.69 747.36 859.46 # 15570 754.75 717.01 824.56 15820 604.68 574.45 660.62 15572 926.16 879.85 1,011.83 # 15820 531.11 504.55 580.23 # 15572 751.84 714.25 821.39 15821 641.92 609.82 701.29 15574 1,002.45 952.33 1,095.18 # 15821 559.29 531.33 611.03 # 15574 821.34 780.27 897.31 15822 482.26 458.15 526.87 15576 899.37 854.40 982.56 # 15822 412.08 391.48 450.20 # 15576 728.45 692.03 795.83 15823 732.91 696.26 800.70 15600 441.09 419.04 481.90 # 15823 656.51 623.68 717.23 # 15600 240.17 228.16 262.38 15830 1,220.24 1,159.23 1,333.11 15610 385.74 366.45 421.42 15832 957.41 909.54 1,045.97 # 15610 278.77 264.83 304.55 15833 894.34 849.62 977.06 15620 540.58 513.55 590.58 15834 910.43 864.91 994.65 # 15620 357.21 339.35 390.25 15835 926.62 880.29 1,012.33 15630 548.27 520.86 598.99 15836 785.86 746.57 858.56 # 15630 388.10 368.70 424.01 15837 847.63 805.25 926.04 15650 583.22 554.06 637.17 # 15837 732.17 695.56 799.89 # 15650 418.52 397.59 457.23 15838 627.56 596.18 685.61 15731 1,205.88 1,145.59 1,317.43 15839 921.19 875.13 1,006.40 # 15731 1,060.99 1,007.94 1,159.13 # 15839 758.76 720.82 828.94 15732 1,673.17 1,589.51 1,827.94 15840 1,091.26 1,036.70 1,192.21 # 15732 1,407.16 1,336.80 1,537.32 15841 1,780.73 1,691.69 1,945.44 15734 1,713.48 1,627.81 1,871.98 15842 2,798.51 2,658.58 3,057.37 # 15734 1,442.38 1,370.26 1,575.80 15845 1,020.70 969.67 1,115.12 15736 1,551.51 1,473.93 1,695.02 15851 117.66 111.78 128.55 # 15736 1,245.32 1,183.05 1,360.51 # 15851 47.48 45.11 51.88 15738 1,630.65 1,549.12 1,781.49 15852 49.19 46.73 53.74 # 15738 1,352.19 1,284.58 1,477.27 15860 115.65 109.87 126.35 15740 1,099.53 1,044.55 1,201.23 15920 621.81 590.72 679.33 # 15740 928.61 882.18 1,014.51 15922 802.39 762.27 876.61 15750 991.82 942.23 1,083.56 15931 701.00 665.95 765.84 15756 2,518.18 2,392.27 2,751.11 15933 875.40 831.63 956.37 15757 2,521.57 2,395.49 2,754.81 15934 967.44 919.07 1,056.93 15758 2,510.14 2,384.63 2,742.32 15935 1,152.79 1,095.15 1,259.42 15760 943.37 896.20 1,030.63 15936 945.69 898.41 1,033.17 # 15760 769.61 731.13 840.80 15937 1,110.45 1,054.93 1,213.17 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 7 FSY08 LOCALITY FEE SCHEDULE FOR AREA 06 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 727.84 691.45 795.17 17276 312.63 297.00 341.55 15941 978.36 929.44 1,068.86 # 17276 222.07 210.97 242.62 15944 946.73 899.39 1,034.30 17280 156.47 148.65 170.95 15945 1,046.24 993.93 1,143.02 # 17280 95.91 91.11 104.78 15946 1,711.98 1,626.38 1,870.34 17281 195.13 185.37 213.18 15950 610.97 580.42 667.48 # 17281 132.31 125.69 144.54 15951 869.42 825.95 949.84 17282 225.44 214.17 246.30 15952 898.25 853.34 981.34 # 17282 152.43 144.81 166.53 15953 1,004.21 954.00 1,097.10 17283 270.30 256.79 295.31 15956 1,214.67 1,153.94 1,327.03 # 17283 189.93 180.43 207.49 15958 1,246.64 1,184.31 1,361.96 17284 313.74 298.05 342.76 16000 78.11 74.20 85.33 # 17284 225.45 214.18 246.31 # 16000 47.55 45.17 51.95 17286 394.30 374.59 430.78 16020 98.05 93.15 107.12 # 17286 304.31 289.09 332.45 # 16020 62.39 59.27 68.16 17311 833.75 792.06 910.87 16025 164.76 156.52 180.00 # 17311 400.21 380.20 437.23 # 16025 121.75 115.66 133.01 17312 511.29 485.73 558.59 16030 199.93 189.93 218.42 # 17312 213.03 202.38 232.74 # 16030 139.94 132.94 152.88 17313 763.52 725.34 834.14 16035 222.50 211.38 243.09 # 17313 359.41 341.44 392.66 16036 87.78 83.39 95.90 17314 472.69 449.06 516.42 17000 90.39 85.87 98.75 # 17314 197.06 187.21 215.29 # 17000 59.26 56.30 64.75 17315 96.54 91.71 105.47 17003 8.87 8.43 9.69 # 17315 56.36 53.54 61.57 # 17003 5.47 5.20 5.98 17340 48.70 46.27 53.21 17004 201.60 191.52 220.25 # 17340 49.27 46.81 53.83 # 17004 151.23 143.67 165.22 17360 146.40 139.08 159.94 17106 436.15 414.34 476.49 # 17360 106.22 100.91 116.05 # 17106 360.31 342.29 393.63 19000 142.13 135.02 155.27 17107 743.82 706.63 812.62 # 19000 48.18 45.77 52.64 # 17107 636.85 605.01 695.76 19001 30.03 28.53 32.81 17108 999.08 949.13 1,091.50 # 19001 23.81 22.62 26.01 # 17108 883.62 839.44 965.36 19020 509.82 484.33 556.98 17110 121.28 115.22 132.50 # 19020 304.94 289.69 333.14 # 17110 69.77 66.28 76.22 19030 213.64 202.96 233.40 17111 145.79 138.50 159.28 # 19030 86.30 81.99 94.29 # 17111 89.19 84.73 97.44 19100 166.56 158.23 181.96 17250 91.01 86.46 99.43 # 19100 69.78 66.29 76.23 # 17250 39.51 37.53 43.16 19101 374.01 355.31 408.61 17260 110.10 104.60 120.29 # 19101 227.42 216.05 248.46 # 17260 73.31 69.64 80.09 19102 281.16 267.10 307.17 17261 159.87 151.88 174.66 # 19102 112.50 106.88 122.91 # 17261 97.61 92.73 106.64 19103 749.77 712.28 819.12 17262 192.30 182.69 210.09 # 19103 207.01 196.66 226.16 # 17262 123.82 117.63 135.27 19105 2,770.86 2,632.32 3,027.17 17263 211.17 200.61 230.70 # 19105 195.12 185.36 213.16 # 17263 135.89 129.10 148.47 19110 503.07 477.92 549.61 17264 227.83 216.44 248.91 # 19110 336.11 319.30 367.20 # 17264 144.63 137.40 158.01 19112 491.32 466.75 536.76 17266 256.46 243.64 280.19 # 19112 307.94 292.54 336.42 # 17266 165.91 157.61 181.25 19120 496.28 471.47 542.19 17270 166.31 157.99 181.69 # 19120 405.72 385.43 443.24 # 17270 104.62 99.39 114.30 19125 544.96 517.71 595.37 17271 181.11 172.05 197.86 # 19125 448.74 426.30 490.25 # 17271 117.73 111.84 128.62 19126 161.96 153.86 176.94 17272 206.80 196.46 225.93 19260 1,277.18 1,213.32 1,395.32 # 17272 136.05 129.25 148.64 19271 1,793.54 1,703.86 1,959.44 17273 229.24 217.78 250.45 19272 1,966.72 1,868.38 2,148.64 # 17273 152.27 144.66 166.36 19290 209.52 199.04 228.90 17274 270.74 257.20 295.78 # 19290 71.43 67.86 78.04 # 17274 185.84 176.55 203.03 19291 89.45 84.98 97.73 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 8 FSY08 LOCALITY FEE SCHEDULE FOR AREA 06 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 35.12 33.36 38.36 # 20225 132.77 126.13 145.05 19295 141.12 134.06 154.17 20240 254.93 242.18 278.51 19296 6,122.81 5,816.67 6,689.17 20245 689.29 654.83 753.05 # 19296 214.62 203.89 234.47 20250 407.23 386.87 444.90 19297 95.52 90.74 104.35 20251 453.28 430.62 495.21 19298 2,040.70 1,938.67 2,229.47 20500 149.12 141.66 162.91 # 19298 351.84 334.25 384.39 # 20500 115.16 109.40 125.81 19300 630.54 599.01 688.86 20501 177.55 168.67 193.97 # 19300 405.85 385.56 443.39 # 20501 42.85 40.71 46.82 19301 602.57 572.44 658.31 20520 227.66 216.28 248.72 19302 887.06 842.71 969.12 # 20520 162.57 154.44 177.61 19303 926.51 880.18 1,012.21 20525 596.20 566.39 651.35 19304 575.60 546.82 628.84 # 20525 273.03 259.38 298.29 19305 1,111.91 1,056.31 1,214.76 20526 86.79 82.45 94.82 19306 1,162.18 1,104.07 1,269.68 # 20526 62.45 59.33 68.23 19307 1,167.40 1,109.03 1,275.38 20550 66.62 63.29 72.78 19316 835.87 794.08 913.19 # 20550 43.41 41.24 47.43 19318 1,225.47 1,164.20 1,338.83 20551 65.86 62.57 71.96 19324 520.45 494.43 568.59 # 20551 46.05 43.75 50.31 19325 698.24 663.33 762.83 20552 61.44 58.37 67.13 19328 529.46 502.99 578.44 # 20552 37.10 35.25 40.54 19330 665.79 632.50 727.38 20553 69.04 65.59 75.43 19340 415.54 394.76 453.97 # 20553 41.31 39.24 45.13 19342 987.01 937.66 1,078.31 20555 347.31 329.94 379.43 19350 1,022.57 971.44 1,117.16 20600 62.59 59.46 68.38 # 19350 740.15 703.14 808.61 # 20600 43.91 41.71 47.97 19355 818.54 777.61 894.25 20605 68.50 65.08 74.84 # 19355 584.22 555.01 638.26 # 20605 45.29 43.03 49.48 19357 1,674.35 1,590.63 1,829.22 20610 87.88 83.49 96.01 19361 1,717.28 1,631.42 1,876.13 # 20610 53.92 51.22 58.90 19364 2,940.15 2,793.14 3,212.11 20612 66.87 63.53 73.06 19366 1,451.80 1,379.21 1,586.09 # 20612 46.50 44.18 50.81 19367 1,937.42 1,840.55 2,116.63 20615 262.79 249.65 287.10 19368 2,362.07 2,243.97 2,580.57 # 20615 179.02 170.07 195.58 19369 2,186.15 2,076.84 2,388.37 20650 223.26 212.10 243.92 19370 736.12 699.31 804.21 # 20650 171.76 163.17 187.65 19371 845.48 803.21 923.69 20660 284.22 270.01 310.51 19380 828.56 787.13 905.20 # 20660 242.91 230.76 265.37 19396 242.85 230.71 265.32 20661 517.25 491.39 565.10 # 19396 148.33 140.91 162.05 20662 528.45 502.03 577.33 20000 236.69 224.86 258.59 20663 494.29 469.58 540.02 # 20000 173.87 165.18 189.96 20664 808.91 768.46 883.73 20005 339.35 322.38 370.74 20665 151.07 143.52 165.05 # 20005 257.28 244.42 281.08 # 20665 117.11 111.25 127.94 20100 622.57 591.44 680.16 20670 582.63 553.50 636.53 20101 478.80 454.86 523.09 # 20670 175.69 166.91 191.95 # 20101 213.36 202.69 233.09 20680 702.57 667.44 767.56 20102 559.67 531.69 611.44 # 20680 443.35 421.18 484.36 # 20102 257.44 244.57 281.26 20690 532.56 505.93 581.82 20103 669.75 636.26 731.70 20692 979.98 930.98 1,070.63 # 20103 380.53 361.50 415.73 20693 515.09 489.34 562.74 20150 980.11 931.10 1,070.77 20694 517.46 491.59 565.33 20200 230.33 218.81 251.63 # 20694 378.80 359.86 413.84 # 20200 97.89 93.00 106.95 20802 2,562.90 2,434.76 2,799.97 20205 309.39 293.92 338.01 20805 3,413.33 3,242.66 3,729.06 # 20205 155.45 147.68 169.83 20808 4,444.60 4,222.37 4,855.73 20206 368.54 350.11 402.63 20816 2,762.39 2,624.27 3,017.91 # 20206 70.84 67.30 77.40 20822 2,437.36 2,315.49 2,662.81 20220 252.73 240.09 276.10 20824 2,724.52 2,588.29 2,976.53 # 20220 88.60 84.17 96.80 20827 2,500.80 2,375.76 2,732.12 20225 1,103.41 1,048.24 1,205.48 20838 2,579.84 2,450.85 2,818.48 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 9 FSY08 LOCALITY FEE SCHEDULE FOR AREA 06 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 725.43 689.16 792.53 # 21076 936.62 889.79 1,023.26 # 20900 525.07 498.82 573.64 21077 2,709.09 2,573.64 2,959.69 20902 676.20 642.39 738.75 # 21077 2,371.77 2,253.18 2,591.16 20910 484.33 460.11 529.13 21079 1,867.71 1,774.32 2,040.47 20912 548.02 520.62 598.71 # 21079 1,578.50 1,499.58 1,724.52 20920 449.81 427.32 491.42 21080 2,124.57 2,018.34 2,321.09 20922 686.70 652.37 750.23 # 21080 1,777.62 1,688.74 1,942.05 # 20922 538.41 511.49 588.21 21081 1,940.51 1,843.48 2,120.00 20924 564.33 536.11 616.53 # 21081 1,616.77 1,535.93 1,766.32 20926 483.34 459.17 528.05 21082 1,779.33 1,690.36 1,943.91 20931 118.55 112.62 129.51 # 21082 1,489.55 1,415.07 1,627.33 20937 182.24 173.13 199.10 21083 1,703.24 1,618.08 1,860.79 20938 197.44 187.57 215.71 # 21083 1,377.80 1,308.91 1,505.25 20950 362.75 344.61 396.30 21084 1,963.10 1,864.95 2,144.69 # 20950 102.41 97.29 111.88 # 21084 1,605.40 1,525.13 1,753.90 20955 2,746.32 2,609.00 3,000.35 21085 778.74 739.80 850.77 20956 2,884.31 2,740.09 3,151.10 # 21085 639.51 607.53 698.66 20957 2,645.37 2,513.10 2,890.07 21086 2,004.82 1,904.58 2,190.27 20962 2,891.83 2,747.24 3,159.33 # 21086 1,756.36 1,668.54 1,918.82 20969 3,066.52 2,913.19 3,350.17 21087 1,989.96 1,890.46 2,174.03 20970 3,030.91 2,879.36 3,311.26 # 21087 1,747.15 1,659.79 1,908.76 20972 2,697.17 2,562.31 2,946.66 21088 2,795.68 2,655.90 3,054.29 20973 2,909.15 2,763.69 3,178.24 21100 917.82 871.93 1,002.72 20974 71.57 67.99 78.19 # 21100 461.65 438.57 504.36 # 20974 53.46 50.79 58.41 21110 862.74 819.60 942.54 20975 192.83 183.19 210.67 # 21110 734.83 698.09 802.80 20979 64.39 61.17 70.35 21116 223.72 212.53 244.41 # 20979 39.49 37.52 43.15 # 21116 46.00 43.70 50.26 20982 5,642.96 5,360.81 6,164.93 21120 763.66 725.48 834.30 # 20982 434.88 413.14 475.11 # 21120 591.04 561.49 645.71 20985 155.18 147.42 169.53 21121 871.03 827.48 951.60 21010 792.16 752.55 865.43 # 21121 730.67 694.14 798.26 21015 478.22 454.31 522.46 21122 812.79 772.15 887.97 21025 1,125.53 1,069.25 1,229.64 21123 935.44 888.67 1,021.97 # 21025 935.93 889.13 1,022.50 21125 3,774.04 3,585.34 4,123.14 21026 683.49 649.32 746.72 # 21125 816.83 775.99 892.39 # 21026 557.84 529.95 609.44 21127 4,087.93 3,883.53 4,466.06 21029 851.06 808.51 929.79 # 21127 949.61 902.13 1,037.45 # 21029 698.25 663.34 762.84 21137 819.00 778.05 894.76 21030 565.79 537.50 618.13 21138 981.82 932.73 1,072.64 # 21030 458.26 435.35 500.65 21139 1,069.67 1,016.19 1,168.62 21031 440.05 418.05 480.76 21141 1,460.90 1,387.86 1,596.04 # 21031 327.42 311.05 357.71 21142 1,413.22 1,342.56 1,543.94 21032 449.73 427.24 491.33 21143 1,517.36 1,441.49 1,657.71 # 21032 321.82 305.73 351.59 21145 1,666.09 1,582.79 1,820.21 21034 1,496.31 1,421.49 1,634.71 21146 1,636.42 1,554.60 1,787.79 # 21034 1,295.96 1,231.16 1,415.83 21147 1,806.67 1,716.34 1,973.79 21040 568.06 539.66 620.61 21150 1,930.21 1,833.70 2,108.76 # 21040 448.07 425.67 489.52 21151 2,060.50 1,957.48 2,251.10 21044 969.62 921.14 1,059.31 21154 2,326.01 2,209.71 2,541.17 21045 1,336.96 1,270.11 1,460.63 21155 2,577.71 2,448.82 2,816.14 21046 1,200.52 1,140.49 1,311.56 21159 2,953.74 2,806.05 3,226.96 21047 1,423.80 1,352.61 1,555.50 21160 3,204.17 3,043.96 3,500.55 21048 1,220.70 1,159.67 1,333.62 21172 1,856.66 1,763.83 2,028.40 21049 1,376.74 1,307.90 1,504.09 21175 2,182.91 2,073.76 2,384.82 21050 943.13 895.97 1,030.37 21179 1,582.29 1,503.18 1,728.66 21060 866.29 822.98 946.43 21180 1,786.30 1,696.99 1,951.54 21070 709.12 673.66 774.71 21181 796.14 756.33 869.78 21073 439.27 417.31 479.91 21182 2,194.96 2,085.21 2,397.99 # 21073 258.72 245.78 282.65 21183 2,499.44 2,374.47 2,730.64 21076 1,097.36 1,042.49 1,198.86 21184 2,558.27 2,430.36 2,794.91 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 06 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 1,836.43 1,744.61 2,006.30 21344 1,652.47 1,569.85 1,805.33 21193 1,350.08 1,282.58 1,474.97 21345 912.34 866.72 996.73 21194 1,546.90 1,469.56 1,689.99 # 21345 725.57 689.29 792.68 21195 1,500.38 1,425.36 1,639.16 21346 1,081.35 1,027.28 1,181.37 21196 1,618.75 1,537.81 1,768.48 21347 1,299.78 1,234.79 1,420.01 21198 1,280.62 1,216.59 1,399.08 21348 1,298.61 1,233.68 1,418.73 21199 1,097.33 1,042.46 1,198.83 21355 505.30 480.04 552.05 21206 1,244.40 1,182.18 1,359.51 # 21355 352.49 334.87 385.10 21208 1,993.26 1,893.60 2,177.64 21356 576.98 548.13 630.35 # 21208 920.17 874.16 1,005.28 # 21356 421.34 400.27 460.31 21209 940.68 893.65 1,027.70 21360 588.01 558.61 642.40 # 21209 727.31 690.94 794.58 21365 1,191.36 1,131.79 1,301.56 21210 2,370.24 2,251.73 2,589.49 21366 1,329.67 1,263.19 1,452.67 # 21210 916.25 870.44 1,001.01 21385 795.31 755.54 868.87 21215 4,082.19 3,878.08 4,459.79 21386 729.10 692.65 796.55 # 21215 949.53 902.05 1,037.36 21387 845.35 803.08 923.54 21230 848.91 806.46 927.43 21390 834.95 793.20 912.18 21235 839.63 797.65 917.30 21395 1,045.27 993.01 1,141.96 # 21235 631.35 599.78 689.75 21400 205.32 195.05 224.31 21240 1,219.24 1,158.28 1,332.02 # 21400 163.43 155.26 178.55 21242 1,130.88 1,074.34 1,235.49 21401 561.20 533.14 613.11 21243 1,821.51 1,730.43 1,989.99 # 21401 320.66 304.63 350.32 21244 1,172.85 1,114.21 1,281.34 21406 599.16 569.20 654.58 21245 1,296.03 1,231.23 1,415.91 21407 700.43 665.41 765.22 # 21245 1,009.08 958.63 1,102.42 21408 946.03 898.73 1,033.54 21246 951.91 904.31 1,039.96 21421 839.73 797.74 917.40 21247 1,770.59 1,682.06 1,934.37 # 21421 718.61 682.68 785.08 21248 1,181.54 1,122.46 1,290.83 21422 757.00 719.15 827.02 # 21248 959.68 911.70 1,048.46 21423 883.41 839.24 965.13 21249 1,635.07 1,553.32 1,786.32 21431 868.78 825.34 949.14 # 21249 1,347.55 1,280.17 1,472.20 21432 751.61 714.03 821.13 21255 1,553.09 1,475.44 1,696.76 21433 1,801.88 1,711.79 1,968.56 21256 1,261.05 1,198.00 1,377.70 21435 1,431.98 1,360.38 1,564.44 21260 1,385.00 1,315.75 1,513.11 21436 2,027.34 1,925.97 2,214.87 21261 2,384.94 2,265.69 2,605.54 21440 611.55 580.97 668.12 21263 2,093.33 1,988.66 2,286.96 # 21440 510.81 485.27 558.06 21267 1,782.77 1,693.63 1,947.67 21445 856.06 813.26 935.25 21268 1,977.89 1,879.00 2,160.85 # 21445 708.91 673.46 774.48 21270 1,037.84 985.95 1,133.84 21450 640.75 608.71 700.02 # 21270 764.47 726.25 835.19 # 21450 547.37 520.00 598.00 21275 877.50 833.63 958.67 21451 840.82 798.78 918.60 21280 584.51 555.28 638.57 # 21451 720.27 684.26 786.90 21282 397.35 377.48 434.10 21452 797.45 757.58 871.22 21295 203.14 192.98 221.93 # 21452 389.95 370.45 426.02 21296 467.02 443.67 510.22 21453 967.96 919.56 1,057.49 21310 142.91 135.76 156.12 # 21453 878.54 834.61 959.80 # 21310 29.15 27.69 31.84 21454 613.14 582.48 669.85 21315 320.38 304.36 350.01 21461 2,218.63 2,107.70 2,423.86 # 21315 170.39 161.87 186.15 # 21461 1,066.31 1,012.99 1,164.94 21320 303.07 287.92 331.11 21462 2,410.75 2,290.21 2,633.74 # 21320 154.79 147.05 169.11 # 21462 1,151.46 1,093.89 1,257.97 21325 593.65 563.97 648.57 21465 999.82 949.83 1,092.30 21330 705.72 670.43 770.99 21470 1,286.28 1,221.97 1,405.27 21335 847.09 804.74 925.45 21480 116.60 110.77 127.39 21336 763.98 725.78 834.65 # 21480 33.40 31.73 36.49 21337 470.13 446.62 513.61 21485 749.48 712.01 818.81 # 21337 324.67 308.44 354.71 # 21485 649.30 616.84 709.37 21338 936.90 890.06 1,023.57 21490 999.43 949.46 1,091.88 21339 992.19 942.58 1,083.97 21495 779.36 740.39 851.45 21340 872.97 829.32 953.72 21497 754.98 717.23 824.81 21343 1,336.35 1,269.53 1,459.96 # 21497 650.84 618.30 711.05 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 11 FSY08 LOCALITY FEE SCHEDULE FOR AREA 06 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 514.90 489.16 562.53 22310 306.54 291.21 334.89 # 21501 355.29 337.53 388.16 # 22310 279.94 265.94 305.83 21502 574.51 545.78 627.65 22315 946.66 899.33 1,034.23 21510 530.14 503.63 579.17 # 22315 810.82 770.28 885.82 21550 302.52 287.39 330.50 22318 1,667.85 1,584.46 1,822.13 # 21550 176.87 168.03 193.23 22319 1,819.34 1,728.37 1,987.63 21555 488.66 464.23 533.86 22325 1,466.86 1,393.52 1,602.55 # 21555 356.22 338.41 389.17 22326 1,528.43 1,452.01 1,669.81 21556 448.32 425.90 489.79 22327 1,514.83 1,439.09 1,654.95 21557 621.08 590.03 678.53 22328 297.38 282.51 324.89 21600 607.14 576.78 663.30 22505 132.09 125.49 144.31 21610 1,129.69 1,073.21 1,234.19 22520 3,349.95 3,182.45 3,659.82 21615 734.52 697.79 802.46 # 22520 637.24 605.38 696.19 21616 898.54 853.61 981.65 22521 3,198.89 3,038.95 3,494.79 21620 580.60 551.57 634.31 # 22521 603.33 573.16 659.13 21627 613.48 582.81 670.23 22522 260.66 247.63 284.77 21630 1,362.02 1,293.92 1,488.01 22523 663.93 630.73 725.34 21632 1,334.37 1,267.65 1,457.80 22524 637.13 605.27 696.06 21685 1,086.18 1,031.87 1,186.65 22525 288.86 274.42 315.58 21700 480.53 456.50 524.98 22526 2,885.76 2,741.47 3,152.69 21705 662.65 629.52 723.95 # 22526 356.99 339.14 390.01 21720 409.66 389.18 447.56 22527 2,406.81 2,286.47 2,629.44 21725 578.65 549.72 632.18 # 22527 159.90 151.91 174.70 21740 1,147.14 1,089.78 1,253.25 22532 1,822.45 1,731.33 1,991.03 21750 763.28 725.12 833.89 22533 1,715.31 1,629.54 1,873.97 21800 113.27 107.61 123.75 22534 390.00 370.50 426.08 # 21800 114.97 109.22 125.60 22548 1,945.05 1,847.80 2,124.97 21805 291.60 277.02 318.57 22554 1,368.31 1,299.89 1,494.87 21810 559.52 531.54 611.27 22556 1,749.06 1,661.61 1,910.85 21820 153.63 145.95 167.84 22558 1,600.12 1,520.11 1,748.13 21825 630.11 598.60 688.39 22585 360.24 342.23 393.56 21920 295.90 281.11 323.28 22590 1,616.04 1,535.24 1,765.53 # 21920 172.52 163.89 188.47 22595 1,542.20 1,465.09 1,684.85 21925 472.67 449.04 516.40 22600 1,324.91 1,258.66 1,447.46 # 21925 361.74 343.65 395.20 22610 1,312.00 1,246.40 1,433.36 21930 527.71 501.32 576.52 22612 1,683.64 1,599.46 1,839.38 # 21930 398.10 378.20 434.93 22614 422.03 400.93 461.07 21935 1,220.84 1,159.80 1,333.77 22630 1,619.36 1,538.39 1,769.15 22010 973.65 924.97 1,063.72 22632 342.22 325.11 373.88 22015 967.48 919.11 1,056.98 22800 1,444.60 1,372.37 1,578.23 22100 875.28 831.52 956.25 22802 2,274.58 2,160.85 2,484.98 22101 877.63 833.75 958.81 22804 2,632.93 2,501.28 2,876.47 22102 881.57 837.49 963.11 22808 1,937.42 1,840.55 2,116.63 22103 152.08 144.48 166.15 22810 2,167.07 2,058.72 2,367.53 22110 1,067.75 1,014.36 1,166.51 22812 2,385.44 2,266.17 2,606.10 22112 1,066.10 1,012.80 1,164.72 22818 2,359.24 2,241.28 2,577.47 22114 1,067.10 1,013.75 1,165.81 22819 2,659.54 2,526.56 2,905.54 22116 151.30 143.74 165.30 22830 869.85 826.36 950.31 22206 2,454.70 2,331.97 2,681.77 22840 823.75 782.56 899.94 22207 2,426.84 2,305.50 2,651.33 22842 824.76 783.52 901.05 22208 598.77 568.83 654.15 22843 871.76 828.17 952.40 22210 1,858.00 1,765.10 2,029.87 22844 1,081.36 1,027.29 1,181.38 22212 1,549.90 1,472.41 1,693.27 22845 783.50 744.33 855.98 22214 1,568.86 1,490.42 1,713.98 22846 814.64 773.91 890.00 22216 396.37 376.55 433.03 22847 899.34 854.37 982.53 22220 1,678.51 1,594.58 1,833.77 22848 393.72 374.03 430.13 22222 1,512.55 1,436.92 1,652.46 22849 1,381.43 1,312.36 1,509.21 22224 1,670.49 1,586.97 1,825.02 22850 769.34 730.87 840.50 22226 394.11 374.40 430.56 22851 436.80 414.96 477.20 22305 208.50 198.08 227.79 22852 738.21 701.30 806.50 # 22305 187.56 178.18 204.91 22855 1,169.20 1,110.74 1,277.35 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 06 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 1,875.98 1,782.18 2,049.51 23412 1,043.23 991.07 1,139.73 22862 2,180.85 2,071.81 2,382.58 23415 809.36 768.89 884.22 22865 2,125.70 2,019.42 2,322.33 23420 1,157.26 1,099.40 1,264.31 22900 426.95 405.60 466.44 23430 816.22 775.41 891.72 23000 635.88 604.09 694.70 23440 839.65 797.67 917.32 # 23000 402.13 382.02 439.32 23450 1,044.08 991.88 1,140.66 23020 759.58 721.60 829.84 23455 1,109.26 1,053.80 1,211.87 23030 521.91 495.81 570.18 23460 1,202.63 1,142.50 1,313.88 # 23030 284.77 270.53 311.11 23462 1,172.94 1,114.29 1,281.43 23031 515.08 489.33 562.73 23465 1,220.02 1,159.02 1,332.87 # 23031 247.95 235.55 270.88 23466 1,211.96 1,151.36 1,324.06 23035 770.11 731.60 841.34 23470 1,329.56 1,263.08 1,452.54 23040 791.04 751.49 864.21 23472 1,630.91 1,549.36 1,781.76 23044 631.60 600.02 690.02 23480 903.66 858.48 987.25 23065 239.90 227.91 262.10 23485 1,053.33 1,000.66 1,150.76 # 23065 181.04 171.99 197.79 23490 898.84 853.90 981.99 23066 600.64 570.61 656.20 23491 1,115.82 1,060.03 1,219.03 # 23066 378.78 359.84 413.82 23500 238.79 226.85 260.88 23075 301.44 286.37 329.33 # 23500 230.87 219.33 252.23 # 23075 192.21 182.60 209.99 23505 384.45 365.23 420.01 23076 609.11 578.65 665.45 # 23505 357.29 339.43 390.34 23077 1,256.90 1,194.06 1,373.17 23515 751.15 713.59 820.63 23100 540.71 513.67 590.72 23520 245.26 233.00 267.95 23101 500.75 475.71 547.07 # 23520 244.13 231.92 266.71 23105 702.19 667.08 767.14 23525 387.01 367.66 422.81 23106 532.76 506.12 582.04 # 23525 355.32 337.55 388.18 23107 730.30 693.79 797.86 23530 606.37 576.05 662.46 23120 621.86 590.77 679.39 23532 685.39 651.12 748.79 23125 768.67 730.24 839.78 23540 244.47 232.25 267.09 23130 673.73 640.04 736.05 # 23540 232.02 220.42 253.48 23140 559.84 531.85 611.63 23545 350.71 333.17 383.15 23145 757.00 719.15 827.02 # 23545 313.36 297.69 342.34 23146 681.45 647.38 744.49 23550 630.67 599.14 689.01 23150 714.63 678.90 780.74 23552 725.41 689.14 792.51 23155 861.48 818.41 941.17 23570 253.19 240.53 276.61 23156 739.63 702.65 808.05 # 23570 253.76 241.07 277.23 23170 588.79 559.35 643.25 23575 427.94 406.54 467.52 23172 612.40 581.78 669.05 # 23575 397.38 377.51 434.14 23174 827.84 786.45 904.42 23585 993.09 943.44 1,084.96 23180 782.98 743.83 855.40 23600 361.05 343.00 394.45 23182 755.11 717.35 824.95 # 23600 320.86 304.82 350.54 23184 841.96 799.86 919.84 23605 520.49 494.47 568.64 23190 612.17 581.56 668.79 # 23605 468.42 445.00 511.75 23195 816.35 775.53 891.86 23615 945.36 898.09 1,032.80 23200 942.00 894.90 1,029.14 23616 1,422.10 1,351.00 1,553.65 23210 988.63 939.20 1,080.08 23620 295.03 280.28 322.32 23220 1,166.19 1,107.88 1,274.06 # 23620 270.12 256.61 295.10 23221 1,353.47 1,285.80 1,478.67 23625 421.77 400.68 460.78 23222 1,815.92 1,725.12 1,983.89 # 23625 388.37 368.95 424.29 23330 271.25 257.69 296.34 23630 794.44 754.72 867.93 # 23330 168.25 159.84 183.82 23650 329.33 312.86 359.79 23331 652.25 619.64 712.59 # 23650 287.45 273.08 314.04 23332 968.73 920.29 1,058.33 23655 415.84 395.05 454.31 23350 212.55 201.92 232.21 23660 638.42 606.50 697.48 # 23350 56.34 53.52 61.55 23665 465.19 441.93 508.22 23395 1,396.30 1,326.49 1,525.46 # 23665 431.23 409.67 471.12 23397 1,243.54 1,181.36 1,358.56 23670 879.75 835.76 961.12 23400 1,065.22 1,011.96 1,163.75 23675 606.85 576.51 662.99 23405 694.47 659.75 758.71 # 23675 550.82 523.28 601.77 23406 860.32 817.30 939.90 23680 963.67 915.49 1,052.81 23410 982.91 933.76 1,073.82 23700 215.46 204.69 235.39 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 06 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 1,116.10 1,060.30 1,219.35 24342 863.27 820.11 943.13 23802 1,311.50 1,245.93 1,432.82 24343 779.59 740.61 851.70 23900 1,427.91 1,356.51 1,559.99 24344 1,192.02 1,132.42 1,302.28 23920 1,166.69 1,108.36 1,274.61 24345 774.69 735.96 846.35 23921 498.14 473.23 544.21 24346 1,188.61 1,129.18 1,298.56 23930 434.69 412.96 474.90 24357 499.46 474.49 545.66 # 23930 236.60 224.77 258.49 24358 580.26 551.25 633.94 23931 361.27 343.21 394.69 24359 696.76 661.92 761.21 # 23931 181.29 172.23 198.06 24360 980.49 931.47 1,071.19 23935 557.62 529.74 609.20 24361 1,103.06 1,047.91 1,205.10 24000 521.53 495.45 569.77 24362 1,043.14 990.98 1,139.63 24006 781.33 742.26 853.60 24363 1,599.61 1,519.63 1,747.57 24065 287.11 272.75 313.66 24365 706.18 670.87 771.50 # 24065 182.41 173.29 199.28 24366 754.50 716.78 824.30 24066 691.88 657.29 755.88 24400 902.62 857.49 986.11 # 24066 432.67 411.04 472.70 24410 1,141.36 1,084.29 1,246.93 24075 564.83 536.59 617.08 24420 1,070.04 1,016.54 1,169.02 # 24075 341.84 324.75 373.46 24430 1,122.03 1,065.93 1,225.82 24076 514.24 488.53 561.81 24435 1,160.03 1,102.03 1,267.33 24077 876.29 832.48 957.35 24470 724.22 688.01 791.21 24100 439.69 417.71 480.37 24495 750.39 712.87 819.80 24101 553.25 525.59 604.43 24498 956.87 909.03 1,045.38 24102 677.82 643.93 740.52 24500 391.29 371.73 427.49 24105 382.00 362.90 417.34 # 24500 340.36 323.34 371.84 24110 641.75 609.66 701.11 24505 557.95 530.05 609.56 24115 718.91 682.96 785.40 # 24505 496.83 471.99 542.79 24116 949.54 902.06 1,037.37 24515 963.30 915.14 1,052.41 24120 576.78 547.94 630.13 24516 947.73 900.34 1,035.39 24125 652.96 620.31 713.36 24530 420.56 399.53 459.46 24126 697.36 662.49 761.86 # 24530 366.80 348.46 400.73 24130 563.02 534.87 615.10 24535 688.06 653.66 751.71 24134 840.81 798.77 918.59 # 24535 626.37 595.05 684.31 24136 692.74 658.10 756.82 24538 828.04 786.64 904.64 24138 729.82 693.33 797.33 24545 976.35 927.53 1,066.66 24140 811.94 771.34 887.04 24546 1,161.20 1,103.14 1,268.61 24145 688.79 654.35 752.50 24560 355.21 337.45 388.07 24147 722.75 686.61 789.60 # 24560 299.18 284.22 326.85 24149 1,251.96 1,189.36 1,367.76 24565 576.42 547.60 629.74 24150 1,061.18 1,008.12 1,159.34 # 24565 520.39 494.37 568.53 24151 1,229.14 1,167.68 1,342.83 24566 767.07 728.72 838.03 24152 790.38 750.86 863.49 24575 814.11 773.40 889.41 24153 731.58 695.00 799.25 24576 374.46 355.74 409.10 24155 915.51 869.73 1,000.19 # 24576 324.66 308.43 354.69 24160 668.97 635.52 730.85 24577 596.86 567.02 652.07 24164 550.06 522.56 600.94 # 24577 539.13 512.17 589.00 24200 242.31 230.19 264.72 24579 913.65 867.97 998.17 # 24200 152.32 144.70 166.41 24582 873.94 830.24 954.78 24201 678.37 644.45 741.12 24586 1,195.51 1,135.73 1,306.09 # 24201 403.31 383.14 440.61 24587 1,187.37 1,128.00 1,297.20 24220 226.79 215.45 247.77 24600 410.40 389.88 448.36 # 24220 73.98 70.28 80.82 # 24600 355.50 337.73 388.39 24300 459.33 436.36 501.81 24605 505.81 480.52 552.60 24301 825.98 784.68 902.38 24615 787.51 748.13 860.35 24305 642.56 610.43 701.99 24620 607.38 577.01 663.56 24310 527.49 501.12 576.29 24635 938.71 891.77 1,025.54 24320 832.07 790.47 909.04 24640 141.67 134.59 154.78 24330 789.84 750.35 862.90 # 24640 91.86 87.27 100.36 24331 866.68 823.35 946.85 24650 290.17 275.66 317.01 24332 662.56 629.43 723.84 # 24650 248.85 236.41 271.87 24340 678.81 644.87 741.60 24655 490.12 465.61 535.45 24341 795.70 755.92 869.31 # 24655 435.22 413.46 475.48 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 ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 14 FSY08 LOCALITY FEE SCHEDULE FOR AREA 06 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 719.74 683.75 786.31 25250 580.92 551.87 634.65 24666 806.83 766.49 881.46 25251 788.01 748.61 860.90 24670 323.32 307.15 353.22 25259 458.75 435.81 501.18 # 24670 277.48 263.61 303.15 25260 864.36 821.14 944.31 24675 510.07 484.57 557.26 25263 854.95 812.20 934.03 # 24675 458.00 435.10 500.37 25265 992.78 943.14 1,084.61 24685 722.03 685.93 788.82 25270 717.56 681.68 783.93 24800 879.28 835.32 960.62 25272 794.04 754.34 867.49 24802 1,077.45 1,023.58 1,177.12 25274 909.63 864.15 993.77 24900 772.12 733.51 843.54 25275 740.57 703.54 809.07 24920 758.70 720.77 828.89 25280 797.73 757.84 871.52 24925 593.01 563.36 647.86 25290 759.65 721.67 829.92 24930 798.39 758.47 872.24 25295 751.14 713.58 820.62 24931 821.46 780.39 897.45 25300 771.64 733.06 843.02 24935 1,150.99 1,093.44 1,257.46 25301 733.18 696.52 801.00 25000 441.72 419.63 482.57 25310 857.44 814.57 936.76 25001 374.45 355.73 409.09 25312 960.72 912.68 1,049.58 25020 700.32 665.30 765.10 25315 1,019.39 968.42 1,113.68 25023 1,275.71 1,211.92 1,393.71 25316 1,173.78 1,115.09 1,282.35 25024 820.20 779.19 896.07 25320 1,077.94 1,024.04 1,177.65 25025 1,231.44 1,169.87 1,345.35 25332 928.02 881.62 1,013.86 25028 612.77 582.13 669.45 25335 1,077.11 1,023.25 1,176.74 25031 485.66 461.38 530.59 25337 1,000.47 950.45 1,093.02 25035 839.09 797.14 916.71 25350 926.51 880.18 1,012.21 25040 648.35 615.93 708.32 25355 1,012.66 962.03 1,106.33 25065 289.12 274.66 315.86 25360 906.65 861.32 990.52 # 25065 184.98 175.73 202.09 25365 1,175.93 1,117.13 1,284.70 25066 471.14 447.58 514.72 25370 1,255.75 1,192.96 1,371.90 25075 406.99 386.64 444.64 25375 1,228.09 1,166.69 1,341.69 25076 579.77 550.78 633.40 25390 1,025.53 974.25 1,120.39 25077 900.91 855.86 984.24 25391 1,265.70 1,202.42 1,382.78 25085 548.39 520.97 599.12 25392 1,264.40 1,201.18 1,381.36 25100 409.52 389.04 447.40 25393 1,412.79 1,342.15 1,543.47 25101 474.60 450.87 518.50 25394 840.95 798.90 918.74 25105 577.69 548.81 631.13 25400 1,072.49 1,018.87 1,171.70 25107 701.30 666.24 766.18 25405 1,321.70 1,255.62 1,443.96 25109 560.19 532.18 612.01 25415 1,250.04 1,187.54 1,365.67 25110 456.77 433.93 499.02 25420 1,456.61 1,383.78 1,591.35 25111 369.45 350.98 403.63 25425 1,374.48 1,305.76 1,501.62 25112 442.45 420.33 483.38 25426 1,364.81 1,296.57 1,491.06 25115 986.09 936.79 1,077.31 25430 775.79 737.00 847.55 25116 834.25 792.54 911.42 25431 864.08 820.88 944.01 25118 452.19 429.58 494.02 25440 872.64 829.01 953.36 2