1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 1 FSY08 LOCALITY FEE SCHEDULE FOR AREA 09 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 43.89 41.70 47.96 # G0268 34.53 32.80 37.72 G0102 25.83 24.54 28.22 G0270 29.47 28.00 32.20 # G0102 9.61 9.13 10.50 # G0270 28.93 27.48 31.60 G0104 166.25 157.94 181.63 G0271 16.29 15.48 17.80 # G0104 66.80 63.46 72.98 # G0271 15.74 14.95 17.19 G0105 478.46 454.54 522.72 G0275 15.74 14.95 17.19 # G0105 228.77 217.33 249.93 G0278 15.74 14.95 17.19 G0105 53 166.25 157.94 181.63 G0281 13.27 12.61 14.50 # G0105 53 66.80 63.46 72.98 G0283 13.27 12.61 14.50 G0106 241.70 229.62 264.06 G0288 318.41 302.49 347.86 G0106 TC 187.24 177.88 204.56 G0289 95.72 90.93 104.57 G0106 26 54.46 51.74 59.50 G0308 852.12 809.51 930.94 G0108 38.56 36.63 42.12 G0309 696.18 661.37 760.58 G0109 21.80 20.71 23.82 G0310 542.86 515.72 593.08 G0117 56.68 53.85 61.93 G0311 582.99 553.84 636.92 G0118 39.88 37.89 43.57 G0312 478.76 454.82 523.04 C G0120 236.83 224.99 258.74 G0313 374.58 355.85 409.23 C G0120 TC 182.37 173.25 199.24 G0314 516.46 490.64 564.24 G0120 26 54.46 51.74 59.50 G0315 423.66 402.48 462.85 G0121 478.46 454.54 522.72 G0316 327.91 311.51 358.24 # G0121 228.77 217.33 249.93 G0317 326.29 309.98 356.48 G0121 53 166.25 157.94 181.63 G0318 266.69 253.36 291.36 # G0121 53 66.80 63.46 72.98 G0319 207.51 197.13 226.70 G0124 29.68 28.20 32.43 G0320 656.73 623.89 717.47 G0127 23.67 22.49 25.86 G0321 459.30 436.34 501.79 # G0127 9.61 9.13 10.50 G0322 400.42 380.40 437.46 G0128 4.15 3.94 4.53 G0323 251.56 238.98 274.83 G0130 47.86 45.47 52.29 G0324 23.78 22.59 25.98 G0130 TC 36.05 34.25 39.39 G0325 13.84 13.15 15.12 G0130 26 11.81 11.22 12.90 G0326 16.03 15.23 17.51 G0141 29.68 28.20 32.43 G0327 8.92 8.47 9.74 G0166 221.00 209.95 241.44 G0329 10.35 9.83 11.30 G0168 112.17 106.56 122.54 G0332 106.47 101.15 116.32 # G0168 28.40 26.98 31.03 G0339 3,915.07 3,719.32 4,277.22 G0179 57.40 54.53 62.71 G0340 2,658.17 2,525.26 2,904.05 G0180 74.07 70.37 80.93 G0341 396.58 376.75 433.26 G0181 125.60 119.32 137.22 G0342 740.03 703.03 808.48 G0182 131.01 124.46 143.13 G0343 1,227.29 1,165.93 1,340.82 G0186 368.26 349.85 402.33 G0344 111.05 105.50 121.33 G0202 178.21 169.30 194.70 # G0344 74.84 71.10 81.77 G0202 TC 139.65 132.67 152.57 G0364 14.62 13.89 15.97 G0202 26 38.56 36.63 42.12 # G0364 9.76 9.27 10.66 G0204 200.79 190.75 219.36 C G0365 222.11 211.00 242.65 G0204 TC 152.62 144.99 166.74 C G0365 TC 208.34 197.92 227.61 G0204 26 48.17 45.76 52.62 G0365 26 13.77 13.08 15.04 G0206 160.19 152.18 175.01 G0366 29.44 27.97 32.17 G0206 TC 121.63 115.55 132.88 G0367 19.83 18.84 21.67 G0206 26 38.56 36.63 42.12 G0368 9.61 9.13 10.50 G0237 18.74 17.80 20.47 G0372 18.26 17.35 19.95 G0238 19.83 18.84 21.67 # G0372 9.07 8.62 9.91 G0239 17.66 16.78 19.30 G0389 153.32 145.65 167.50 G0245 76.28 72.47 83.34 G0389 TC 120.92 114.87 132.10 # G0245 48.71 46.27 53.21 G0389 26 32.40 30.78 35.40 G0246 46.59 44.26 50.90 G0392 3,188.40 3,028.98 3,483.33 # G0246 24.98 23.73 27.29 # G0392 543.41 516.24 593.68 G0247 50.95 48.40 55.66 G0393 2,439.01 2,317.06 2,664.62 # G0247 28.25 26.84 30.87 # G0393 349.07 331.62 381.36 G0248 270.95 257.40 296.01 G0396 33.96 32.26 37.10 G0249 199.07 189.12 217.49 # G0396 31.80 30.21 34.74 G0250 10.57 10.04 11.55 G0397 65.95 62.65 72.05 G0268 57.77 54.88 63.11 # G0397 63.25 60.09 69.10 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 09 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 27.08 25.73 29.59 10022 174.68 165.95 190.84 G9042 12.54 11.91 13.70 # 10022 69.83 66.34 76.29 G9043 12.54 11.91 13.70 10040 107.47 102.10 117.42 G9044 10.92 10.37 11.93 # 10040 91.79 87.20 100.28 M0064 47.30 44.94 51.68 10060 119.03 113.08 130.04 # M0064 18.66 17.73 20.39 # 10060 100.11 95.10 109.37 P3001 29.68 28.20 32.43 10061 198.05 188.15 216.37 Q0035 26.74 25.40 29.21 # 10061 173.73 165.04 189.80 Q0035 TC 17.66 16.78 19.30 10080 201.53 191.45 220.17 Q0035 26 9.07 8.62 9.91 # 10080 105.33 100.06 115.07 Q0091 52.35 49.73 57.19 10081 298.65 283.72 326.28 # Q0091 20.47 19.45 22.37 # 10081 173.80 165.11 189.88 Q0092 21.80 20.71 23.82 10120 158.10 150.20 172.73 R0070 191.66 182.08 209.39 # 10120 98.65 93.72 107.78 R0075 191.66 182.08 209.39 10121 294.38 279.66 321.61 0016T 368.26 349.85 402.33 # 10121 197.64 187.76 215.92 0030T 26.31 24.99 28.74 10140 168.78 160.34 184.39 0067T 595.17 565.41 650.22 # 10140 129.33 122.86 141.29 C 0067T TC 257.62 244.74 281.45 10160 139.68 132.70 152.61 0067T 26 72.54 68.91 79.25 # 10160 105.09 99.84 114.82 0073T 845.51 803.23 923.71 10180 257.58 244.70 281.41 0075T 1,295.17 1,230.41 1,414.97 # 10180 191.11 181.55 208.78 0075T 26 904.50 859.28 988.17 11000 58.28 55.37 63.68 0076T 427.41 406.04 466.95 # 11000 33.42 31.75 36.51 0076T 26 90.45 85.93 98.82 11001 23.89 22.70 26.11 0078T 1,594.34 1,514.62 1,741.81 # 11001 16.87 16.03 18.43 0079T 153.43 145.76 167.62 11004 596.51 566.68 651.68 0080T 276.48 262.66 302.06 11005 787.38 748.01 860.21 0081T 27.65 26.27 30.21 11006 737.45 700.58 805.67 0144T 321.60 305.52 351.35 11008 282.48 268.36 308.61 C 0144T TC 135.75 128.96 148.30 11010 534.07 507.37 583.48 0144T 26 60.30 57.29 65.88 # 11010 298.43 283.51 326.04 0145T 477.38 453.51 521.54 11011 603.84 573.65 659.70 0145T TC 402.00 381.90 439.19 # 11011 310.92 295.37 339.68 0145T 26 75.38 71.61 82.35 11012 841.70 799.62 919.56 0146T 633.15 601.49 691.71 # 11012 458.52 435.59 500.93 C 0146T TC 402.39 382.27 439.61 11040 51.68 49.10 56.47 0146T 26 100.50 95.48 109.80 # 11040 28.99 27.54 31.67 0147T 633.15 601.49 691.71 11041 61.00 57.95 66.64 C 0147T TC 402.39 382.27 439.61 # 11041 37.76 35.87 41.25 0147T 26 100.50 95.48 109.80 11042 83.16 79.00 90.85 0148T 633.15 601.49 691.71 # 11042 49.65 47.17 54.25 C 0148T TC 402.39 382.27 439.61 11043 302.37 287.25 330.34 0148T 26 100.50 95.48 109.80 # 11043 256.97 244.12 280.74 0149T 633.15 601.49 691.71 11044 408.57 388.14 446.36 C 0149T TC 402.39 382.27 439.61 # 11044 355.61 337.83 388.50 0149T 26 100.50 95.48 109.80 11055 53.35 50.68 58.28 0150T 633.15 601.49 691.71 # 11055 24.16 22.95 26.39 C 0150T TC 402.39 382.27 439.61 11056 64.64 61.41 70.62 0150T 26 100.50 95.48 109.80 # 11056 33.84 32.15 36.97 0151T 201.00 190.95 219.59 11057 77.20 73.34 84.34 C 0151T TC 135.75 128.96 148.30 # 11057 44.23 42.02 48.32 0151T 26 60.30 57.29 65.88 11100 114.15 108.44 124.71 0159T 24.84 23.60 27.14 # 11100 50.38 47.86 55.04 0159T TC 21.39 20.32 23.37 11101 35.22 33.46 38.48 0159T 26 3.47 3.30 3.80 # 11101 25.49 24.22 27.85 0171T 886.17 841.86 968.14 11200 90.68 86.15 99.07 0172T 443.08 420.93 484.07 # 11200 74.47 70.75 81.36 0177T 1,587.93 1,508.53 1,734.81 11201 19.74 18.75 21.56 10021 165.32 157.05 180.61 # 11201 17.58 16.70 19.21 # 10021 72.91 69.26 79.65 11300 78.03 74.13 85.25 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 09 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 30.47 28.95 33.29 11451 518.53 492.60 566.49 11301 102.47 97.35 111.95 # 11451 315.32 299.55 344.48 # 11301 52.21 49.60 57.04 11462 394.04 374.34 430.49 11302 121.56 115.48 132.80 # 11462 232.98 221.33 254.53 # 11302 64.27 61.06 70.22 11463 528.98 502.53 577.91 11303 144.08 136.88 157.41 # 11463 319.82 303.83 349.40 # 11303 75.44 71.67 82.42 11470 425.03 403.78 464.35 11305 77.51 73.63 84.67 # 11470 272.62 258.99 297.84 # 11305 38.60 36.67 42.17 11471 542.85 515.71 593.07 11306 105.28 100.02 115.02 # 11471 341.80 324.71 373.42 # 11306 58.80 55.86 64.24 11600 204.56 194.33 223.48 11307 123.07 116.92 134.46 # 11600 115.93 110.13 126.65 # 11307 68.48 65.06 74.82 11601 241.56 229.48 263.90 11308 138.94 131.99 151.79 # 11601 149.14 141.68 162.93 # 11308 82.73 78.59 90.38 11602 263.16 250.00 287.50 11310 94.69 89.96 103.45 # 11602 162.10 154.00 177.10 # 11310 44.43 42.21 48.54 11603 296.00 281.20 323.38 11311 116.16 110.35 126.90 # 11603 190.07 180.57 207.66 # 11311 64.81 61.57 70.81 11604 325.74 309.45 355.87 11312 135.09 128.34 147.59 # 11604 206.84 196.50 225.98 # 11312 74.56 70.83 81.45 11606 445.65 423.37 486.88 11313 168.92 160.47 184.54 # 11606 300.81 285.77 328.64 # 11313 99.74 94.75 108.96 11620 206.41 196.09 225.50 11400 137.72 130.83 150.45 # 11620 117.24 111.38 128.09 # 11400 82.05 77.95 89.64 11621 243.59 231.41 266.12 11401 161.80 153.71 176.77 # 11621 151.17 143.61 165.15 # 11401 106.13 100.82 115.94 11622 273.76 260.07 299.08 11402 178.81 169.87 195.35 # 11622 173.23 164.57 189.26 # 11402 115.57 109.79 126.26 11623 316.24 300.43 345.49 11403 202.76 192.62 221.51 # 11623 210.31 199.79 229.76 # 11403 146.55 139.22 160.10 11624 355.55 337.77 388.44 11404 229.61 218.13 250.85 # 11624 238.81 226.87 260.90 # 11404 160.97 152.92 175.86 11626 433.55 411.87 473.65 11406 310.48 294.96 339.20 # 11626 301.68 286.60 329.59 # 11406 233.20 221.54 254.77 11640 215.59 204.81 235.53 11420 135.24 128.48 147.75 # 11640 125.87 119.58 137.52 # 11420 88.22 83.81 96.38 11641 260.06 247.06 284.12 11421 170.44 161.92 186.21 # 11641 164.94 156.69 180.19 # 11421 116.40 110.58 127.17 11642 297.78 282.89 325.32 11422 189.77 180.28 207.32 # 11642 192.93 183.28 210.77 # 11422 140.05 133.05 153.01 11643 345.65 328.37 377.63 11423 219.67 208.69 239.99 # 11643 237.56 225.68 259.53 # 11423 161.30 153.24 176.23 11644 426.49 405.17 465.95 11424 249.91 237.41 273.02 # 11644 295.70 280.92 323.06 # 11424 185.05 175.80 202.17 11646 551.98 524.38 603.04 11426 346.29 328.98 378.33 # 11646 415.25 394.49 453.66 # 11426 274.41 260.69 299.79 11719 23.31 22.14 25.46 11440 152.10 144.50 166.18 # 11719 9.80 9.31 10.71 # 11440 109.40 103.93 119.52 11720 33.91 32.21 37.04 11441 184.40 175.18 201.46 # 11720 17.69 16.81 19.33 # 11441 139.00 132.05 151.86 11721 47.57 45.19 51.97 11442 206.04 195.74 225.10 # 11721 30.28 28.77 33.09 # 11442 153.08 145.43 167.24 11730 106.37 101.05 116.21 11443 244.53 232.30 267.15 # 11730 62.05 58.95 67.79 # 11443 186.70 177.37 203.98 11732 48.40 45.98 52.88 11444 303.97 288.77 332.09 # 11732 31.65 30.07 34.58 # 11444 235.87 224.08 257.69 11740 50.56 48.03 55.23 11446 400.33 380.31 437.36 # 11740 35.43 33.66 38.71 # 11446 327.90 311.51 358.24 11750 229.45 217.98 250.68 11450 395.09 375.34 431.64 # 11750 189.46 179.99 206.99 # 11450 240.52 228.49 262.76 11752 323.47 307.30 353.40 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 09 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 288.34 273.92 315.01 12013 193.61 183.93 211.52 11755 147.30 139.94 160.93 # 12013 125.52 119.24 137.13 # 11755 91.10 86.55 99.53 12014 225.50 214.23 246.36 11760 224.72 213.48 245.50 # 12014 149.30 141.84 163.12 # 11760 149.05 141.60 162.84 12015 282.06 267.96 308.15 11762 290.05 275.55 316.88 # 12015 185.86 176.57 203.06 # 11762 220.88 209.84 241.32 12016 331.56 314.98 362.23 11765 147.99 140.59 161.68 # 12016 225.63 214.35 246.50 # 11765 75.02 71.27 81.96 12017 272.69 259.06 297.92 11770 289.33 274.86 316.09 12018 326.07 309.77 356.24 # 11770 183.40 174.23 200.36 12020 304.45 289.23 332.61 11771 562.89 534.75 614.96 # 12020 200.68 190.65 219.25 # 11771 420.21 399.20 459.08 12021 171.52 162.94 187.38 11772 699.12 664.16 763.78 # 12021 146.12 138.81 159.63 # 11772 566.17 537.86 618.54 12031 248.92 236.47 271.94 11900 61.50 58.43 67.19 # 12031 155.97 148.17 170.40 # 11900 31.77 30.18 34.71 12032 338.12 321.21 369.39 11901 74.29 70.58 81.17 # 12032 203.54 193.36 222.36 # 11901 49.42 46.95 53.99 12034 322.23 306.12 352.04 11920 226.22 214.91 247.15 # 12034 204.41 194.19 223.32 # 11920 121.92 115.82 133.19 12035 415.92 395.12 454.39 11921 254.37 241.65 277.90 # 12035 247.30 234.94 270.18 # 11921 143.58 136.40 156.86 12036 454.00 431.30 496.00 11922 74.70 70.97 81.62 # 12036 287.00 272.65 313.55 # 11922 32.00 30.40 34.96 12037 508.57 483.14 555.61 11950 86.22 81.91 94.20 # 12037 333.46 316.79 364.31 # 11950 51.63 49.05 56.41 12041 263.62 250.44 288.01 11951 110.20 104.69 120.39 # 12041 168.50 160.08 184.09 # 11951 68.58 65.15 74.92 12042 313.07 297.42 342.03 11952 158.45 150.53 173.11 # 12042 200.11 190.10 218.62 # 11952 103.33 98.16 112.88 12044 352.59 334.96 385.20 11954 186.43 177.11 203.68 # 12044 215.32 204.55 235.23 # 11954 116.71 110.87 127.50 12045 418.31 397.39 457.00 11960 991.24 941.68 1,082.93 # 12045 257.26 244.40 281.06 11970 637.21 605.35 696.15 12046 493.25 468.59 538.88 11971 569.06 540.61 621.70 # 12046 300.85 285.81 328.68 # 11971 333.96 317.26 364.85 12047 526.80 500.46 575.53 11976 161.60 153.52 176.55 # 12047 334.94 318.19 365.92 # 11976 99.99 94.99 109.24 12051 293.46 278.79 320.61 11980 114.39 108.67 124.97 # 12051 185.36 176.09 202.50 # 11980 83.59 79.41 91.32 12052 323.37 307.20 353.28 11981 153.12 145.46 167.28 # 12052 213.11 202.45 232.82 # 11981 89.89 85.40 98.21 12053 351.98 334.38 384.54 11982 174.91 166.16 191.08 # 12053 217.41 206.54 237.52 # 11982 108.97 103.52 119.05 12054 374.97 356.22 409.65 11983 257.23 244.37 281.03 # 12054 231.20 219.64 252.59 # 11983 199.40 189.43 217.84 12055 453.33 430.66 495.26 12001 165.58 157.30 180.90 # 12055 283.63 269.45 309.87 # 12001 105.59 100.31 115.36 12056 561.41 533.34 613.34 12002 175.38 166.61 191.60 # 12056 353.87 336.18 386.61 # 12002 118.63 112.70 129.61 12057 602.93 572.78 658.70 12004 204.86 194.62 223.81 # 12057 407.82 387.43 445.54 # 12004 138.39 131.47 151.19 13100 348.21 330.80 380.42 12005 254.06 241.36 277.56 # 13100 248.23 235.82 271.19 # 12005 170.83 162.29 186.63 13101 433.96 412.26 474.10 12006 314.68 298.95 343.79 # 13101 300.47 285.45 328.27 # 12006 215.77 204.98 235.73 13102 115.46 109.69 126.14 12007 352.48 334.86 385.09 # 13102 77.09 73.24 84.23 # 12007 247.09 234.74 269.95 13120 360.89 342.85 394.28 12011 176.89 168.05 193.26 # 13120 258.20 245.29 282.08 # 12011 109.33 103.86 119.44 13121 475.39 451.62 519.36 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 09 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 337.04 320.19 368.22 15120 1,016.13 965.32 1,110.12 13122 132.98 126.33 145.28 # 15120 831.30 789.74 908.20 # 13122 87.58 83.20 95.68 15121 318.14 302.23 347.56 13131 396.46 376.64 433.14 # 15121 188.43 179.01 205.86 # 13131 293.23 278.57 320.36 15130 768.81 730.37 839.93 13132 614.35 583.63 671.17 # 15130 609.38 578.91 665.75 # 13132 487.89 463.50 533.03 15131 104.81 99.57 114.51 13133 178.59 169.66 195.11 # 15131 88.59 84.16 96.78 # 13133 136.98 130.13 149.65 15135 942.28 895.17 1,029.45 13150 404.29 384.08 441.69 # 15135 829.32 787.85 906.03 # 13150 292.96 278.31 320.06 15136 99.76 94.77 108.99 13151 446.71 424.37 488.03 # 15136 90.03 85.53 98.36 # 13151 339.70 322.72 371.13 15150 777.73 738.84 849.67 13152 604.52 574.29 660.43 # 15150 688.56 654.13 752.25 # 13152 452.65 430.02 494.52 15151 136.68 129.85 149.33 13153 198.61 188.68 216.98 # 15151 118.84 112.90 129.84 # 13153 149.42 141.95 163.24 15152 167.47 159.10 182.97 13160 841.85 799.76 919.72 # 15152 148.55 141.12 162.29 14000 712.78 677.14 778.71 15155 802.75 762.61 877.00 # 14000 570.10 541.60 622.84 # 15155 743.30 706.14 812.06 14001 916.04 870.24 1,000.78 15156 179.43 170.46 196.03 # 14001 757.15 719.29 827.18 # 15156 165.38 157.11 180.68 14020 793.95 754.25 867.39 15157 200.41 190.39 218.95 # 14020 652.89 620.25 713.29 # 15157 180.41 171.39 197.10 14021 1,028.19 976.78 1,123.30 15170 439.40 417.43 480.04 # 14021 879.02 835.07 960.33 # 15170 361.57 343.49 395.01 14040 831.36 789.79 908.26 15171 94.20 89.49 102.91 # 14040 701.65 666.57 766.56 # 15171 88.79 84.35 97.00 14041 1,127.22 1,070.86 1,231.49 15175 573.06 544.41 626.07 # 14041 960.76 912.72 1,049.63 # 15175 498.48 473.56 544.59 14060 841.51 799.43 919.34 15176 152.28 144.67 166.37 # 14060 737.21 700.35 805.40 # 15176 142.55 135.42 155.73 14061 1,225.15 1,163.89 1,338.47 15200 866.04 822.74 946.15 # 14061 1,042.47 990.35 1,138.90 # 15200 683.37 649.20 746.58 14300 1,169.59 1,111.11 1,277.78 15201 175.12 166.36 191.31 # 14300 1,006.37 956.05 1,099.46 # 15201 80.54 76.51 87.99 14350 797.25 757.39 871.00 15220 835.52 793.74 912.80 15002 369.53 351.05 403.71 # 15220 665.82 632.53 727.41 # 15002 232.79 221.15 254.32 15221 163.00 154.85 178.08 15003 79.55 75.57 86.91 # 15221 74.91 71.16 81.83 # 15003 44.96 42.71 49.12 15240 986.74 937.40 1,078.01 15004 441.42 419.35 482.25 # 15240 841.36 799.29 919.18 # 15004 286.85 272.51 313.39 15241 206.47 196.15 225.57 15005 129.24 122.78 141.20 # 15241 118.37 112.45 129.32 # 15005 90.87 86.33 99.28 15260 1,054.47 1,001.75 1,152.01 15040 306.72 291.38 335.09 # 15260 910.71 865.17 994.95 # 15040 135.94 129.14 148.51 15261 238.21 226.30 260.25 15050 598.54 568.61 653.90 # 15261 153.90 146.21 168.14 # 15050 479.10 455.15 523.42 15300 357.19 339.33 390.23 15100 981.78 932.69 1,072.59 # 15300 296.12 281.31 323.51 # 15100 769.38 730.91 840.55 15301 63.75 60.56 69.64 15101 234.26 222.55 255.93 # 15301 58.34 55.42 63.73 # 15101 121.30 115.24 132.53 15320 405.37 385.10 442.87 15110 944.14 896.93 1,031.47 # 15320 337.82 320.93 369.07 # 15110 780.38 741.36 852.56 15321 95.62 90.84 104.47 15111 130.41 123.89 142.47 # 15321 88.05 83.65 96.20 # 15111 109.87 104.38 120.04 15330 334.34 317.62 365.26 15115 926.38 880.06 1,012.07 # 15330 271.65 258.07 296.78 # 15115 808.56 768.13 883.35 15331 64.29 61.08 70.24 15116 171.97 163.37 187.88 # 15331 59.42 56.45 64.92 # 15116 150.35 142.83 164.25 15335 357.26 339.40 390.31 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 6 FSY08 LOCALITY FEE SCHEDULE FOR AREA 09 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 294.02 279.32 321.22 15770 696.54 661.71 760.97 15336 94.04 89.34 102.74 15775 345.55 328.27 377.51 # 15336 84.85 80.61 92.70 # 15775 221.25 210.19 241.72 15340 351.64 334.06 384.17 15776 490.35 465.83 535.70 # 15340 290.03 275.53 316.86 # 15776 347.67 330.29 379.83 15341 52.77 50.13 57.65 15780 936.36 889.54 1,022.97 # 15341 28.45 27.03 31.08 # 15780 720.72 684.68 787.38 15360 402.51 382.38 439.74 15781 606.03 575.73 662.09 # 15360 329.55 313.07 360.03 # 15781 482.26 458.15 526.87 15361 73.43 69.76 80.22 15782 666.76 633.42 728.43 # 15361 65.32 62.05 71.36 # 15782 475.98 452.18 520.01 15365 398.25 378.34 435.09 15783 562.26 534.15 614.27 # 15365 331.77 315.18 362.46 # 15783 409.86 389.37 447.78 15366 92.69 88.06 101.27 15786 272.88 259.24 298.13 # 15366 84.58 80.35 92.40 # 15786 145.87 138.58 159.37 15400 411.10 390.55 449.13 15787 64.58 61.35 70.55 # 15400 378.14 359.23 413.11 # 15787 19.19 18.23 20.96 15401 117.25 111.39 128.10 15788 515.16 489.40 562.81 # 15401 59.96 56.96 65.50 # 15788 272.49 258.87 297.70 15420 463.56 440.38 506.44 15789 655.32 622.55 715.93 # 15420 402.49 382.37 439.73 # 15789 469.41 445.94 512.83 15421 125.34 119.07 136.93 15792 504.57 479.34 551.24 # 15421 88.05 83.65 96.20 # 15792 314.33 298.61 343.40 15430 592.85 563.21 647.69 15793 531.23 504.67 580.37 # 15430 570.16 541.65 622.90 # 15793 392.87 373.23 429.21 15570 966.44 918.12 1,055.84 15819 771.94 733.34 843.34 # 15570 740.53 703.50 809.03 15820 589.50 560.03 644.03 15572 904.09 858.89 987.72 # 15820 519.24 493.28 567.27 # 15572 737.63 700.75 805.86 15821 626.18 594.87 684.10 15574 978.09 929.19 1,068.57 # 15821 547.28 519.92 597.91 # 15574 805.14 764.88 879.61 15822 469.46 445.99 512.89 15576 877.15 833.29 958.28 # 15822 402.45 382.33 439.68 # 15576 713.94 678.24 779.98 15823 715.99 680.19 782.22 15600 425.07 403.82 464.39 # 15823 643.03 610.88 702.51 # 15600 233.21 221.55 254.78 15830 1,198.62 1,138.69 1,309.49 15610 373.23 354.57 407.76 15832 939.29 892.33 1,026.18 # 15610 271.08 257.53 296.16 15833 877.18 833.32 958.32 15620 523.39 497.22 571.80 15834 893.08 848.43 975.69 # 15620 348.28 330.87 380.50 15835 910.16 864.65 994.35 15630 531.39 504.82 580.54 15836 771.05 732.50 842.38 # 15630 378.44 359.52 413.45 15837 827.97 786.57 904.56 15650 566.13 537.82 618.49 # 15837 717.71 681.82 784.09 # 15650 408.86 388.42 446.68 15838 615.29 584.53 672.21 15731 1,179.50 1,120.53 1,288.61 15839 900.11 855.10 983.37 # 15731 1,041.14 989.08 1,137.44 # 15839 744.99 707.74 813.90 15732 1,636.78 1,554.94 1,788.18 15840 1,071.34 1,017.77 1,170.44 # 15732 1,382.77 1,313.63 1,510.67 15841 1,751.37 1,663.80 1,913.37 15734 1,675.08 1,591.33 1,830.03 15842 2,752.90 2,615.26 3,007.55 # 15734 1,416.20 1,345.39 1,547.20 15845 1,002.55 952.42 1,095.28 15736 1,515.04 1,439.29 1,655.18 15851 114.07 108.37 124.63 # 15736 1,222.65 1,161.52 1,335.75 # 15851 47.05 44.70 51.41 15738 1,594.57 1,514.84 1,742.07 15852 48.68 46.25 53.19 # 15738 1,328.67 1,262.24 1,451.58 15860 114.31 108.59 124.88 15740 1,072.94 1,019.29 1,172.18 15920 609.92 579.42 666.33 # 15740 909.72 864.23 993.86 15922 786.46 747.14 859.21 15750 972.33 923.71 1,062.27 15931 689.11 654.65 752.85 15756 2,477.39 2,353.52 2,706.55 15933 858.89 815.95 938.34 15757 2,481.12 2,357.06 2,710.62 15934 950.62 903.09 1,038.55 15758 2,469.67 2,346.19 2,698.12 15935 1,131.66 1,075.08 1,236.34 15760 920.02 874.02 1,005.12 15936 928.86 882.42 1,014.78 # 15760 754.10 716.40 823.86 15937 1,090.07 1,035.57 1,190.91 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 7 FSY08 LOCALITY FEE SCHEDULE FOR AREA 09 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 715.04 679.29 781.18 17276 304.94 289.69 333.14 15941 958.49 910.57 1,047.16 # 17276 218.46 207.54 238.67 15944 928.32 881.90 1,014.19 17280 151.78 144.19 165.82 15945 1,025.93 974.63 1,120.82 # 17280 93.96 89.26 102.65 15946 1,681.92 1,597.82 1,837.49 17281 189.79 180.30 207.35 15950 599.10 569.15 654.52 # 17281 129.80 123.31 141.81 15951 852.81 810.17 931.70 17282 219.36 208.39 239.65 15952 881.78 837.69 963.34 # 17282 149.64 142.16 163.48 15953 985.44 936.17 1,076.60 17283 263.39 250.22 287.75 15956 1,192.75 1,133.11 1,303.08 # 17283 186.65 177.32 203.92 15958 1,223.18 1,162.02 1,336.32 17284 306.00 290.70 334.31 16000 76.35 72.53 83.41 # 17284 221.69 210.61 242.20 # 16000 47.16 44.80 51.52 17286 385.37 366.10 421.02 16020 95.21 90.45 104.02 # 17286 299.43 284.46 327.13 # 16020 61.16 58.10 66.82 17311 808.48 768.06 883.27 16025 161.00 152.95 175.89 # 17311 394.49 374.77 430.99 # 16025 119.93 113.93 131.02 17312 494.81 470.07 540.58 16030 195.03 185.28 213.07 # 17312 209.99 199.49 229.41 # 16030 137.75 130.86 150.49 17313 740.15 703.14 808.61 16035 219.87 208.88 240.21 # 17313 354.26 336.55 387.03 16036 86.79 82.45 94.82 17314 457.44 434.57 499.76 17000 87.55 83.17 95.65 # 17314 194.24 184.53 212.21 # 17000 57.83 54.94 63.18 17315 93.93 89.23 102.61 17003 8.60 8.17 9.40 # 17315 55.55 52.77 60.69 # 17003 5.36 5.09 5.85 17340 48.02 45.62 52.46 17004 196.12 186.31 214.26 # 17340 48.56 46.13 53.05 # 17004 148.02 140.62 161.71 17360 142.67 135.54 155.87 17106 425.66 404.38 465.04 # 17360 104.30 99.09 113.95 # 17106 353.24 335.58 385.92 19000 137.39 130.52 150.10 17107 728.52 692.09 795.90 # 19000 47.67 45.29 52.08 # 17107 626.37 595.05 684.31 19001 29.51 28.03 32.23 17108 980.30 931.29 1,070.98 # 19001 23.57 22.39 25.75 # 17108 870.04 826.54 950.52 19020 494.23 469.52 539.95 17110 117.14 111.28 127.97 # 19020 298.59 283.66 326.21 # 17110 67.96 64.56 74.24 19030 207.05 196.70 226.21 17111 141.09 134.04 154.15 # 19030 85.45 81.18 93.36 # 17111 87.04 82.69 95.09 19100 161.57 153.49 176.51 17250 87.90 83.51 96.04 # 19100 69.15 65.69 75.54 # 17250 38.71 36.77 42.29 19101 363.49 345.32 397.12 17260 106.98 101.63 116.87 # 19101 223.51 212.33 244.18 # 17260 71.85 68.26 78.50 19102 272.45 258.83 297.65 17261 155.03 147.28 169.37 # 19102 111.39 105.82 121.69 # 17261 95.58 90.80 104.42 19103 723.29 687.13 790.20 17262 186.82 177.48 204.10 # 19103 204.99 194.74 223.95 # 17262 121.42 115.35 132.65 19105 2,653.25 2,520.59 2,898.68 17263 205.23 194.97 224.22 # 19105 193.64 183.96 211.55 # 17263 133.35 126.68 145.68 19110 489.00 464.55 534.23 17264 221.46 210.39 241.95 # 19110 329.57 313.09 360.05 # 17264 142.02 134.92 155.16 19112 476.54 452.71 520.62 17266 249.60 237.12 272.69 # 19112 301.43 286.36 329.31 # 17266 163.12 154.96 178.20 19120 485.46 461.19 530.37 17270 161.47 153.40 176.41 # 19120 398.99 379.04 435.90 # 17270 102.56 97.43 112.04 19125 533.43 506.76 582.77 17271 175.95 167.15 192.22 # 19125 441.56 419.48 482.40 # 17271 115.42 109.65 126.10 19126 160.46 152.44 175.31 17272 201.04 190.99 219.64 19260 1,254.46 1,191.74 1,370.50 # 17272 133.48 126.81 145.83 19271 1,755.98 1,668.18 1,918.41 17273 223.01 211.86 243.64 19272 1,927.22 1,830.86 2,105.49 # 17273 149.51 142.03 163.33 19290 202.60 192.47 221.34 17274 263.72 250.53 288.11 # 19290 70.73 67.19 77.27 # 17274 182.65 173.52 199.55 19291 86.66 82.33 94.68 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 09 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 34.77 33.03 37.98 # 20225 130.49 123.97 142.57 19295 134.76 128.02 147.22 20240 249.86 237.37 272.98 19296 5,853.95 5,561.25 6,395.44 20245 675.55 641.77 738.04 # 19296 212.15 201.54 231.77 20250 399.05 379.10 435.97 19297 94.61 89.88 103.36 20251 444.08 421.88 485.16 19298 1,960.59 1,862.56 2,141.94 20500 144.87 137.63 158.27 # 19298 347.88 330.49 380.06 # 20500 112.44 106.82 122.84 19300 612.41 581.79 669.06 20501 171.06 162.51 186.89 # 19300 397.85 377.96 434.65 # 20501 42.43 40.31 46.36 19301 595.25 565.49 650.31 20520 221.10 210.05 241.56 19302 874.55 830.82 955.44 # 20520 158.95 151.00 173.65 19303 915.84 870.05 1,000.56 20525 576.27 547.46 629.58 19304 565.12 536.86 617.39 # 20525 267.67 254.29 292.43 19305 1,095.91 1,041.11 1,197.28 20526 84.74 80.50 92.58 19306 1,145.15 1,087.89 1,251.07 # 20526 61.50 58.43 67.19 19307 1,150.33 1,092.81 1,256.73 20550 65.10 61.85 71.13 19316 819.91 778.91 895.75 # 20550 42.94 40.79 46.91 19318 1,201.65 1,141.57 1,312.81 20551 64.37 61.15 70.32 19324 510.16 484.65 557.35 # 20551 45.46 43.19 49.67 19325 683.60 649.42 746.83 20552 59.98 56.98 65.53 19328 518.15 492.24 566.08 # 20552 36.74 34.90 40.14 19330 652.37 619.75 712.71 20553 67.42 64.05 73.66 19340 409.31 388.84 447.17 # 20553 40.93 38.88 44.71 19342 967.05 918.70 1,056.51 20555 343.55 326.37 375.33 19350 994.25 944.54 1,086.22 20600 61.07 58.02 66.72 # 19350 724.56 688.33 791.58 # 20600 43.24 41.08 47.24 19355 798.22 758.31 872.06 20605 66.76 63.42 72.93 # 19355 574.47 545.75 627.61 # 20605 44.60 42.37 48.73 19357 1,639.56 1,557.58 1,791.22 20610 85.49 81.22 93.40 19361 1,685.73 1,601.44 1,841.66 # 20610 53.06 50.41 57.97 19364 2,891.49 2,746.92 3,158.96 20612 65.25 61.99 71.29 19366 1,429.28 1,357.82 1,561.49 # 20612 45.80 43.51 50.04 19367 1,902.69 1,807.56 2,078.69 20615 255.51 242.73 279.14 19368 2,322.04 2,205.94 2,536.83 # 20615 175.52 166.74 191.75 19369 2,148.98 2,041.53 2,347.76 20650 217.65 206.77 237.79 19370 720.73 684.69 787.39 # 20650 168.47 160.05 184.06 19371 827.98 786.58 904.57 20660 279.32 265.35 305.15 19380 811.41 770.84 886.47 # 20660 239.86 227.87 262.05 19396 236.19 224.38 258.04 20661 504.08 478.88 550.71 # 19396 145.94 138.64 159.44 20662 517.04 491.19 564.87 20000 230.25 218.74 251.55 20663 483.12 458.96 527.80 # 20000 170.26 161.75 186.01 20664 791.92 752.32 865.17 20005 331.09 314.54 361.72 20665 146.89 139.55 160.48 # 20005 252.72 240.08 276.09 # 20665 114.46 108.74 125.05 20100 614.97 584.22 671.85 20670 559.84 531.85 611.63 20101 463.60 440.42 506.48 # 20670 171.25 162.69 187.09 # 20101 210.12 199.61 229.55 20680 682.60 648.47 745.74 20102 542.26 515.15 592.42 # 20680 435.07 413.32 475.32 # 20102 253.66 240.98 277.13 20690 525.72 499.43 574.34 20103 650.07 617.57 710.21 20692 967.55 919.17 1,057.05 # 20103 373.90 355.21 408.49 20693 503.67 478.49 550.26 20150 964.83 916.59 1,054.08 20694 502.44 477.32 548.92 20200 222.84 211.70 243.46 # 20694 370.03 351.53 404.26 # 20200 96.37 91.55 105.28 20802 2,531.24 2,404.68 2,765.38 20205 300.10 285.10 327.87 20805 3,360.83 3,192.79 3,671.71 # 20205 153.09 145.44 167.26 20808 4,368.60 4,150.17 4,772.70 20206 353.89 336.20 386.63 20816 2,700.66 2,565.63 2,950.47 # 20206 69.61 66.13 76.05 20822 2,379.73 2,260.74 2,599.85 20220 243.86 231.67 266.42 20824 2,664.49 2,531.27 2,910.96 # 20220 87.13 82.77 95.19 20827 2,441.98 2,319.88 2,667.86 20225 1,057.37 1,004.50 1,155.18 20838 2,548.14 2,420.73 2,783.84 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 9 FSY08 LOCALITY FEE SCHEDULE FOR AREA 09 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 704.13 668.92 769.26 # 21076 920.91 874.86 1,006.09 # 20900 512.81 487.17 560.25 21077 2,653.67 2,520.99 2,899.14 20902 661.50 628.43 722.69 # 21077 2,331.56 2,214.98 2,547.23 20910 473.20 449.54 516.97 21079 1,827.67 1,736.29 1,996.73 20912 536.02 509.22 585.60 # 21079 1,551.49 1,473.92 1,695.01 20920 440.26 418.25 480.99 21080 2,078.36 1,974.44 2,270.61 20922 669.29 635.83 731.20 # 21080 1,747.06 1,659.71 1,908.67 # 20922 527.69 501.31 576.51 21081 1,898.24 1,803.33 2,073.83 20924 551.92 524.32 602.97 # 21081 1,589.10 1,509.65 1,736.10 20926 472.83 449.19 516.57 21082 1,740.34 1,653.32 1,901.32 20931 116.76 110.92 127.56 # 21082 1,463.62 1,390.44 1,599.01 20937 179.54 170.56 196.14 21083 1,664.57 1,581.34 1,818.54 20938 194.50 184.78 212.50 # 21083 1,353.81 1,286.12 1,479.04 20950 348.89 331.45 381.17 21084 1,919.16 1,823.20 2,096.68 # 20950 100.28 95.27 109.56 # 21084 1,577.59 1,498.71 1,723.52 20955 2,701.75 2,566.66 2,951.66 21085 761.43 723.36 831.86 20956 2,835.17 2,693.41 3,097.42 # 21085 628.48 597.06 686.62 20957 2,609.80 2,479.31 2,851.21 21086 1,963.66 1,865.48 2,145.30 20962 2,838.97 2,697.02 3,101.57 # 21086 1,726.40 1,640.08 1,886.09 20969 3,017.65 2,866.77 3,296.79 21087 1,949.48 1,852.01 2,129.81 20970 2,981.83 2,832.74 3,257.65 # 21087 1,717.63 1,631.75 1,876.51 20972 2,663.09 2,529.94 2,909.43 21088 2,795.68 2,655.90 3,054.29 20973 2,870.98 2,727.43 3,136.54 21100 885.50 841.23 967.41 20974 69.58 66.10 76.02 # 21100 449.89 427.40 491.51 # 20974 52.28 49.67 57.12 21110 835.33 793.56 912.59 20975 189.27 179.81 206.78 # 21110 713.19 677.53 779.16 20979 62.72 59.58 68.52 21116 215.23 204.47 235.14 # 20979 38.94 36.99 42.54 # 21116 45.53 43.25 49.74 20982 5,402.95 5,132.80 5,902.72 21120 739.10 702.15 807.47 # 20982 429.68 408.20 469.43 # 21120 574.26 545.55 627.38 20985 153.12 145.46 167.28 21121 847.01 804.66 925.36 21010 778.05 739.15 850.02 # 21121 712.98 677.33 778.93 21015 467.72 444.33 510.98 21122 793.15 753.49 866.51 21025 1,096.72 1,041.88 1,198.16 21123 915.48 869.71 1,000.17 # 21025 915.66 869.88 1,000.36 21125 3,625.06 3,443.81 3,960.38 21026 663.65 630.47 725.04 # 21125 801.18 761.12 875.29 # 21026 543.67 516.49 593.96 21127 3,927.86 3,731.47 4,291.19 21029 829.05 787.60 905.74 # 21127 931.04 884.49 1,017.16 # 21029 683.13 648.97 746.32 21137 802.11 762.00 876.30 21030 549.80 522.31 600.66 21138 962.75 914.61 1,051.80 # 21030 447.12 424.76 488.47 21139 1,051.00 998.45 1,148.22 21031 426.66 405.33 466.13 21141 1,433.20 1,361.54 1,565.77 # 21031 319.11 303.15 348.62 21142 1,389.07 1,319.62 1,517.56 21032 435.95 414.15 476.27 21143 1,490.10 1,415.60 1,627.94 # 21032 313.81 298.12 342.84 21145 1,637.80 1,555.91 1,789.30 21034 1,462.88 1,389.74 1,598.20 21146 1,611.24 1,530.68 1,760.28 # 21034 1,271.56 1,207.98 1,389.18 21147 1,777.09 1,688.24 1,941.48 21040 551.96 524.36 603.01 21150 1,894.29 1,799.58 2,069.52 # 21040 437.39 415.52 477.85 21151 2,024.82 1,923.58 2,212.12 21044 950.90 903.36 1,038.86 21154 2,282.73 2,168.59 2,493.88 21045 1,312.66 1,247.03 1,434.08 21155 2,530.59 2,404.06 2,764.67 21046 1,174.04 1,115.34 1,282.64 21159 2,905.32 2,760.05 3,174.06 21047 1,398.90 1,328.96 1,528.30 21160 3,152.81 2,995.17 3,444.45 21048 1,194.31 1,134.59 1,304.78 21172 1,828.54 1,737.11 1,997.68 21049 1,352.51 1,284.88 1,477.61 21175 2,150.65 2,043.12 2,349.59 21050 923.46 877.29 1,008.88 21179 1,555.57 1,477.79 1,699.46 21060 848.85 806.41 927.37 21180 1,756.16 1,668.35 1,918.60 21070 693.97 659.27 758.16 21181 780.39 741.37 852.58 21073 426.05 404.75 465.46 21182 2,160.36 2,052.34 2,360.19 # 21073 253.65 240.97 277.12 21183 2,457.18 2,334.32 2,684.47 21076 1,074.40 1,020.68 1,173.78 21184 2,519.08 2,393.13 2,752.10 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 09 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 1,799.22 1,709.26 1,965.65 21344 1,620.28 1,539.27 1,770.16 21193 1,326.14 1,259.83 1,448.80 21345 888.79 844.35 971.00 21194 1,519.87 1,443.88 1,660.46 # 21345 710.44 674.92 776.16 21195 1,470.19 1,396.68 1,606.18 21346 1,054.96 1,002.21 1,152.54 21196 1,586.51 1,507.18 1,733.26 21347 1,267.66 1,204.28 1,384.92 21198 1,253.57 1,190.89 1,369.52 21348 1,274.42 1,210.70 1,392.31 21199 1,080.83 1,026.79 1,180.81 21355 491.08 466.53 536.51 21206 1,218.77 1,157.83 1,331.50 # 21355 345.16 327.90 377.09 21208 1,925.49 1,829.22 2,103.60 21356 560.29 532.28 612.12 # 21208 900.79 855.75 984.11 # 21356 411.66 391.08 449.74 21209 913.27 867.61 997.75 21360 575.43 546.66 628.66 # 21209 709.52 674.04 775.15 21365 1,170.40 1,111.88 1,278.66 21210 2,285.96 2,171.66 2,497.41 21366 1,306.23 1,240.92 1,427.06 # 21210 897.53 852.65 980.55 21385 778.21 739.30 850.20 21215 3,921.77 3,725.68 4,284.53 21386 714.97 679.22 781.10 # 21215 930.36 883.84 1,016.42 21387 827.06 785.71 903.57 21230 832.55 790.92 909.56 21390 819.27 778.31 895.06 21235 816.28 775.47 891.79 21395 1,027.12 975.76 1,122.12 # 21235 617.39 586.52 674.50 21400 198.92 188.97 217.32 21240 1,195.49 1,135.72 1,306.08 # 21400 158.92 150.97 173.62 21242 1,108.25 1,052.84 1,210.77 21401 542.96 515.81 593.18 21243 1,786.95 1,697.60 1,952.24 # 21401 313.27 297.61 342.25 21244 1,146.45 1,089.13 1,252.50 21406 586.64 557.31 640.91 21245 1,263.13 1,199.97 1,379.97 21407 686.51 652.18 750.01 # 21245 989.12 939.66 1,080.61 21408 928.48 882.06 1,014.37 21246 934.31 887.59 1,020.73 21421 813.36 772.69 888.59 21247 1,738.40 1,651.48 1,899.20 # 21421 697.70 662.82 762.24 21248 1,153.09 1,095.44 1,259.76 21422 739.95 702.95 808.39 # 21248 941.24 894.18 1,028.31 21423 864.79 821.55 944.78 21249 1,598.10 1,518.20 1,745.93 21431 844.97 802.72 923.13 # 21249 1,323.55 1,257.37 1,445.98 21432 735.08 698.33 803.08 21255 1,518.97 1,443.02 1,659.47 21433 1,772.43 1,683.81 1,936.38 21256 1,238.74 1,176.80 1,353.32 21435 1,407.11 1,336.75 1,537.26 21260 1,357.78 1,289.89 1,483.37 21436 1,995.43 1,895.66 2,180.01 21261 2,344.38 2,227.16 2,561.23 21440 590.48 560.96 645.10 21263 2,059.88 1,956.89 2,250.42 # 21440 494.28 469.57 540.01 21267 1,742.96 1,655.81 1,904.18 21445 829.43 787.96 906.15 21268 1,941.72 1,844.63 2,121.32 # 21445 688.91 654.46 752.63 21270 1,011.92 961.32 1,105.52 21450 618.91 587.96 676.15 # 21270 750.88 713.34 820.34 # 21450 529.73 503.24 578.73 21275 861.02 817.97 940.67 21451 813.73 773.04 889.00 21280 571.88 543.29 624.78 # 21451 698.61 663.68 763.23 21282 387.60 368.22 423.45 21452 766.04 727.74 836.90 21295 197.58 187.70 215.86 # 21452 376.91 358.06 411.77 21296 455.23 432.47 497.34 21453 937.01 890.16 1,023.68 21310 137.62 130.74 150.35 # 21453 851.62 809.04 930.40 # 21310 28.99 27.54 31.67 21454 599.70 569.72 655.18 21315 309.47 294.00 338.10 21461 2,136.58 2,029.75 2,334.21 # 21315 166.25 157.94 181.63 # 21461 1,036.22 984.41 1,132.07 21320 293.10 278.45 320.22 21462 2,323.38 2,207.21 2,538.29 # 21320 151.50 143.93 165.52 # 21462 1,120.87 1,064.83 1,224.55 21325 574.95 546.20 628.13 21465 980.25 931.24 1,070.93 21330 685.16 650.90 748.54 21470 1,262.44 1,199.32 1,379.22 21335 826.58 785.25 903.04 21480 112.56 106.93 122.97 21336 742.55 705.42 811.23 # 21480 33.11 31.45 36.17 21337 455.39 432.62 497.51 21485 724.75 688.51 791.79 # 21337 316.50 300.68 345.78 # 21485 629.09 597.64 687.29 21338 908.04 862.64 992.04 21490 979.50 930.53 1,070.11 21339 964.08 915.88 1,053.26 21495 757.23 719.37 827.28 21340 856.08 813.28 935.27 21497 729.76 693.27 797.26 21343 1,304.07 1,238.87 1,424.70 # 21497 630.32 598.80 688.62 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 09 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 499.35 474.38 545.54 22310 300.02 285.02 327.77 # 21501 346.95 329.60 379.04 # 22310 274.62 260.89 300.02 21502 563.31 535.14 615.41 22315 923.56 877.38 1,008.99 21510 518.24 492.33 566.18 # 22315 793.85 754.16 867.28 21550 293.00 278.35 320.10 22318 1,637.11 1,555.25 1,788.54 # 21550 173.02 164.37 189.03 22319 1,786.91 1,697.56 1,952.19 21555 475.33 451.56 519.29 22325 1,439.47 1,367.50 1,572.63 # 21555 348.87 331.43 381.14 22326 1,500.27 1,425.26 1,639.05 21556 439.27 417.31 479.91 22327 1,487.06 1,412.71 1,624.62 21557 610.73 580.19 667.22 22328 293.05 278.40 320.16 21600 593.90 564.21 648.84 22505 129.84 123.35 141.85 21610 1,109.88 1,054.39 1,212.55 22520 3,217.04 3,056.19 3,514.62 21615 721.81 685.72 788.58 # 22520 626.64 595.31 684.61 21616 882.83 838.69 964.49 22521 3,071.64 2,918.06 3,355.77 21620 568.60 540.17 621.20 # 22521 593.12 563.46 647.98 21627 600.02 570.02 655.52 22522 257.41 244.54 281.22 21630 1,338.24 1,271.33 1,462.03 22523 652.20 619.59 712.53 21632 1,312.83 1,247.19 1,434.27 22524 625.81 594.52 683.70 21685 1,066.75 1,013.41 1,165.42 22525 284.68 270.45 311.02 21700 471.24 447.68 514.83 22526 2,767.65 2,629.27 3,023.66 21705 652.23 619.62 712.56 # 22526 352.90 335.26 385.55 21720 402.51 382.38 439.74 22527 2,304.28 2,189.07 2,517.43 21725 566.59 538.26 619.00 # 22527 158.68 150.75 173.36 21740 1,130.00 1,073.50 1,234.53 22532 1,791.32 1,701.75 1,957.01 21750 751.32 713.75 820.81 22533 1,686.70 1,602.37 1,842.73 21800 110.10 104.60 120.29 22534 384.23 365.02 419.77 # 21800 111.72 106.13 122.05 22548 1,910.37 1,814.85 2,087.08 21805 284.01 269.81 310.28 22554 1,341.19 1,274.13 1,465.25 21810 547.98 520.58 598.67 22556 1,718.61 1,632.68 1,877.58 21820 149.29 141.83 163.10 22558 1,574.15 1,495.44 1,719.76 21825 616.84 586.00 673.90 22585 354.89 337.15 387.72 21920 286.69 272.36 313.21 22590 1,585.73 1,506.44 1,732.41 # 21920 168.87 160.43 184.49 22595 1,513.01 1,437.36 1,652.96 21925 460.36 437.34 502.94 22600 1,299.12 1,234.16 1,419.28 # 21925 354.43 336.71 387.22 22610 1,286.57 1,222.24 1,405.58 21930 513.95 488.25 561.49 22612 1,653.92 1,571.22 1,806.90 # 21930 390.18 370.67 426.27 22614 415.69 394.91 454.15 21935 1,202.19 1,142.08 1,313.39 22630 1,589.55 1,510.07 1,736.58 22010 954.63 906.90 1,042.94 22632 337.10 320.25 368.29 22015 948.52 901.09 1,036.25 22800 1,417.60 1,346.72 1,548.73 22100 857.14 814.28 936.42 22802 2,235.06 2,123.31 2,441.81 22101 859.56 816.58 939.07 22804 2,587.92 2,458.52 2,827.30 22102 863.33 820.16 943.18 22808 1,904.04 1,808.84 2,080.17 22103 149.85 142.36 163.71 22810 2,131.25 2,024.69 2,328.39 22110 1,046.85 994.51 1,143.69 22812 2,345.15 2,227.89 2,562.07 22112 1,045.43 993.16 1,142.13 22818 2,320.39 2,204.37 2,535.03 22114 1,046.38 994.06 1,143.17 22819 2,617.01 2,486.16 2,859.08 22116 149.05 141.60 162.84 22830 852.60 809.97 931.47 22206 2,417.17 2,296.31 2,640.76 22840 811.32 770.75 886.36 22207 2,389.58 2,270.10 2,610.62 22842 812.36 771.74 887.50 22208 590.85 561.31 645.51 22843 859.00 816.05 938.46 22210 1,823.82 1,732.63 1,992.52 22844 1,065.04 1,011.79 1,163.56 22212 1,520.98 1,444.93 1,661.67 22845 771.71 733.12 843.09 22214 1,539.16 1,462.20 1,681.53 22846 802.36 762.24 876.58 22216 390.40 370.88 426.51 22847 885.98 841.68 967.93 22220 1,647.59 1,565.21 1,799.99 22848 387.79 368.40 423.66 22222 1,489.48 1,415.01 1,627.26 22849 1,356.81 1,288.97 1,482.32 22224 1,640.30 1,558.29 1,792.03 22850 753.88 716.19 823.62 22226 388.24 368.83 424.15 22851 430.32 408.80 470.12 22305 203.21 193.05 222.01 22852 723.26 687.10 790.17 # 22305 183.21 174.05 200.16 22855 1,147.61 1,090.23 1,253.76 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 09 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 1,844.71 1,752.47 2,015.34 23412 1,022.98 971.83 1,117.60 22862 2,146.65 2,039.32 2,345.22 23415 792.83 753.19 866.17 22865 2,092.24 1,987.63 2,285.77 23420 1,134.26 1,077.55 1,239.18 22900 419.87 398.88 458.71 23430 799.29 759.33 873.23 23000 615.90 585.11 672.88 23440 822.60 781.47 898.69 # 23000 392.70 373.07 429.03 23450 1,023.86 972.67 1,118.57 23020 743.61 706.43 812.39 23455 1,088.00 1,033.60 1,188.64 23030 505.18 479.92 551.91 23460 1,179.41 1,120.44 1,288.51 # 23030 278.73 264.79 304.51 23462 1,150.91 1,093.36 1,257.36 23031 497.32 472.45 543.32 23465 1,196.96 1,137.11 1,307.68 # 23031 242.22 230.11 264.63 23466 1,188.06 1,128.66 1,297.96 23035 753.26 715.60 822.94 23470 1,304.71 1,239.47 1,425.39 23040 774.41 735.69 846.04 23472 1,601.82 1,521.73 1,749.99 23044 617.92 587.02 675.07 23480 885.50 841.23 967.41 23065 233.61 221.93 255.22 23485 1,033.09 981.44 1,128.66 # 23065 177.40 168.53 193.81 23490 882.16 838.05 963.76 23066 581.90 552.81 635.73 23491 1,093.98 1,039.28 1,195.17 # 23066 370.04 351.54 404.27 23500 232.25 220.64 253.74 23075 292.61 277.98 319.68 # 23500 224.69 213.46 245.48 # 23075 188.31 178.89 205.72 23505 374.51 355.78 409.15 23076 597.02 567.17 652.25 # 23505 348.56 331.13 380.80 23077 1,236.03 1,174.23 1,350.36 23515 736.15 699.34 804.24 23100 528.36 501.94 577.23 23520 238.58 226.65 260.65 23101 489.31 464.84 534.57 # 23520 237.50 225.63 259.47 23105 687.06 652.71 750.62 23525 376.83 357.99 411.69 23106 520.64 494.61 568.80 # 23525 346.56 329.23 378.61 23107 714.68 678.95 780.79 23530 593.60 563.92 648.51 23120 608.12 577.71 664.37 23532 670.47 636.95 732.49 23125 752.82 715.18 822.46 23540 237.97 226.07 259.98 23130 658.44 625.52 719.35 # 23540 226.08 214.78 247.00 23140 548.46 521.04 599.20 23545 341.47 324.40 373.06 23145 741.22 704.16 809.78 # 23545 305.80 290.51 334.09 23146 666.46 633.14 728.11 23550 617.03 586.18 674.11 23150 699.80 664.81 764.53 23552 709.90 674.41 775.57 23155 843.83 801.64 921.89 23570 246.29 233.98 269.08 23156 724.07 687.87 791.05 # 23570 246.83 234.49 269.66 23170 576.28 547.47 629.59 23575 416.81 395.97 455.37 23172 599.04 569.09 654.45 # 23575 387.62 368.24 423.48 23174 810.10 769.60 885.04 23585 976.20 927.39 1,066.50 23180 765.17 726.91 835.95 23600 350.70 333.17 383.15 23182 737.82 700.93 806.07 # 23600 312.33 296.71 341.22 23184 823.28 782.12 899.44 23605 506.79 481.45 553.67 23190 599.12 569.16 654.53 # 23605 457.07 434.22 499.35 23195 799.80 759.81 873.78 23615 926.73 880.39 1,012.45 23200 924.62 878.39 1,010.15 23616 1,393.90 1,324.21 1,522.84 23210 970.09 921.59 1,059.83 23620 286.60 272.27 313.11 23220 1,144.00 1,086.80 1,249.82 # 23620 262.82 249.68 287.13 23221 1,328.85 1,262.41 1,451.77 23625 410.63 390.10 448.62 23222 1,784.37 1,695.15 1,949.42 # 23625 378.74 359.80 413.77 23330 262.73 249.59 287.03 23630 779.20 740.24 851.28 # 23330 164.37 156.15 179.57 23650 321.30 305.24 351.03 23331 637.68 605.80 696.67 # 23650 281.31 267.24 307.33 23332 949.24 901.78 1,037.05 23655 406.28 385.97 443.87 23350 204.95 194.70 223.91 23660 624.56 593.33 682.33 # 23350 55.78 52.99 60.94 23665 453.20 430.54 495.12 23395 1,369.52 1,301.04 1,496.20 # 23665 420.77 399.73 459.69 23397 1,220.34 1,159.32 1,333.22 23670 864.10 820.90 944.04 23400 1,044.34 992.12 1,140.94 23675 591.61 562.03 646.33 23405 679.82 645.83 742.70 # 23675 538.11 511.20 587.88 23406 843.08 800.93 921.07 23680 945.94 898.64 1,033.44 23410 963.56 915.38 1,052.69 23700 210.78 200.24 230.28 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 09 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 1,094.63 1,039.90 1,195.89 24342 845.58 803.30 923.80 23802 1,288.32 1,223.90 1,407.49 24343 762.23 724.12 832.74 23900 1,404.21 1,334.00 1,534.10 24344 1,167.88 1,109.49 1,275.91 23920 1,145.81 1,088.52 1,251.80 24345 757.55 719.67 827.62 23921 486.78 462.44 531.81 24346 1,164.62 1,106.39 1,272.35 23930 420.96 399.91 459.90 24357 487.45 463.08 532.54 # 23930 231.80 220.21 253.24 24358 567.04 538.69 619.49 23931 348.55 331.12 380.79 24359 682.86 648.72 746.03 # 23931 176.69 167.86 193.04 24360 961.05 913.00 1,049.95 23935 544.88 517.64 595.29 24361 1,081.56 1,027.48 1,181.60 24000 509.85 484.36 557.01 24362 1,026.12 974.81 1,121.03 24006 765.13 726.87 835.90 24363 1,571.98 1,493.38 1,717.39 24065 278.34 264.42 304.08 24365 691.15 656.59 755.08 # 24065 178.35 169.43 194.84 24366 738.79 701.85 807.13 24066 671.09 637.54 733.17 24400 884.04 839.84 965.82 # 24066 423.56 402.38 462.74 24410 1,119.46 1,063.49 1,223.01 24075 547.21 519.85 597.83 24420 1,048.65 996.22 1,145.65 # 24075 334.27 317.56 365.19 24430 1,101.26 1,046.20 1,203.13 24076 503.63 478.45 550.22 24435 1,136.89 1,080.05 1,242.06 24077 860.42 817.40 940.01 24470 708.99 673.54 774.57 24100 429.72 408.23 469.46 24495 732.99 696.34 800.79 24101 540.54 513.51 590.54 24498 937.77 890.88 1,024.51 24102 663.38 630.21 724.74 24500 380.17 361.16 415.33 24105 372.03 353.43 406.44 # 24500 331.53 314.95 362.19 24110 627.57 596.19 685.62 24505 543.17 516.01 593.41 24115 706.27 670.96 771.60 # 24505 484.80 460.56 529.64 24116 930.66 884.13 1,016.75 24515 943.53 896.35 1,030.80 24120 564.05 535.85 616.23 24516 928.87 882.43 1,014.79 24125 639.39 607.42 698.53 24530 408.65 388.22 446.45 24126 682.75 648.61 745.90 # 24530 357.31 339.44 390.36 24130 550.12 522.61 601.00 24535 670.80 637.26 732.85 24134 822.87 781.73 898.99 # 24535 611.89 581.30 668.50 24136 677.90 644.01 740.61 24538 809.74 769.25 884.64 24138 713.40 677.73 779.39 24545 958.04 910.14 1,046.66 24140 793.97 754.27 867.41 24546 1,137.95 1,081.05 1,243.21 24145 672.96 639.31 735.21 24560 344.88 327.64 376.79 24147 705.36 670.09 770.60 # 24560 291.38 276.81 318.33 24149 1,227.02 1,165.67 1,340.52 24565 561.59 533.51 613.54 24150 1,040.41 988.39 1,136.65 # 24565 508.08 482.68 555.08 24151 1,205.52 1,145.24 1,317.03 24566 750.01 712.51 819.39 24152 775.01 736.26 846.70 24575 796.23 756.42 869.88 24153 721.88 685.79 788.66 24576 363.40 345.23 397.01 24155 897.91 853.01 980.96 # 24576 315.84 300.05 345.06 24160 654.42 621.70 714.96 24577 581.56 552.48 635.35 24164 537.79 510.90 587.54 # 24577 526.43 500.11 575.13 24200 234.91 223.16 256.63 24579 894.72 849.98 977.48 # 24200 148.98 141.53 162.76 24582 854.10 811.40 933.11 24201 656.91 624.06 717.67 24586 1,172.53 1,113.90 1,280.99 # 24201 394.25 374.54 430.72 24587 1,164.78 1,106.54 1,272.52 24220 219.16 208.20 239.43 24600 400.38 380.36 437.41 # 24220 73.23 69.57 80.01 # 24600 347.96 330.56 380.14 24300 446.26 423.95 487.54 24605 493.88 469.19 539.57 24301 809.02 768.57 883.86 24615 771.23 732.67 842.57 24305 628.44 597.02 686.57 24620 593.99 564.29 648.93 24310 515.64 489.86 563.34 24635 913.41 867.74 997.90 24320 815.80 775.01 891.26 24640 137.69 130.81 150.43 24330 773.36 734.69 844.89 # 24640 90.13 85.62 98.46 24331 849.02 806.57 927.56 24650 281.46 267.39 307.50 24332 648.05 615.65 708.00 # 24650 242.01 229.91 264.40 24340 663.95 630.75 725.36 24655 476.89 453.05 521.01 24341 778.11 739.20 850.08 # 24655 424.47 403.25 463.74 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 14 FSY08 LOCALITY FEE SCHEDULE FOR AREA 09 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 703.54 668.36 768.61 25250 567.89 539.50 620.43 24666 789.72 750.23 862.76 25251 771.69 733.11 843.08 24670 313.89 298.20 342.93 25259 445.70 423.42 486.93 # 24670 270.11 256.60 295.09 25260 841.00 798.95 918.79 24675 496.55 471.72 542.48 25263 832.04 790.44 909.01 # 24675 446.83 424.49 488.16 25265 967.73 919.34 1,057.24 24685 705.70 670.42 770.98 25270 697.20 662.34 761.69 24800 861.93 818.83 941.65 25272 772.28 733.67 843.72 24802 1,056.91 1,004.06 1,154.67 25274 886.08 841.78 968.05 24900 757.16 719.30 827.20 25275 724.64 688.41 791.67 24920 744.30 707.09 813.15 25280 776.16 737.35 847.95 24925 580.49 551.47 634.19 25290 735.96 699.16 804.03 24930 783.60 744.42 856.08 25295 730.35 693.83 797.90 24931 810.78 770.24 885.78 25300 754.42 716.70 824.21 24935 1,131.36 1,074.79 1,236.01 25301 716.88 681.04 783.20 25000 428.61 407.18 468.26 25310 835.12 793.36 912.36 25001 364.85 346.61 398.60 25312 936.60 889.77 1,023.24 25020 680.56 646.53 743.51 25315 994.32 944.60 1,086.29 25023 1,245.29 1,183.03 1,360.48 25316 1,146.12 1,088.81 1,252.13 25024 804.24 764.03 878.63 25320 1,053.85 1,001.16 1,151.33 25025 1,211.15 1,150.59 1,323.18 25332 909.11 863.65 993.20 25028 595.64 565.86 650.74 25335 1,054.77 1,002.03 1,152.33 25031 472.03 448.43 515.69 25337 978.00 929.10 1,068.47 25035 816.17 775.36 891.66 25350 902.47 857.35 985.95 25040 633.78 602.09 692.40 25355 987.59 938.21 1,078.94 25065 280.07 266.07 305.98 25360 882.82 838.68 964.48 # 25065 180.63 171.60 197.34 25365 1,148.16 1,090.75 1,254.36 25066 458.16 435.25 500.54 25370 1,226.69 1,165.36 1,340.16 25075 396.13 376.32 432.77 25375 1,199.24 1,139.28 1,310.17 25076 563.47 535.30 615.60 25390 1,000.22 950.21 1,092.74 25077 879.89 835.90 961.29 25391 1,236.60 1,174.77 1,350.99 25085 534.65 507.92 584.11 25392 1,235.98 1,174.18 1,350.31 25100 398.86 378.92 435.76 25393 1,381.55 1,312.47 1,509.34 25101 462.57 439.44 505.36 25394 824.22 783.01 900.46 25105 563.32 535.15 615.42 25400 1,046.20 993.89 1,142.97 25107 684.52 650.29 747.83 25405 1,291.52 1,226.94 1,410.98 25109 548.42 521.00 599.15 25415 1,220.70 1,159.67 1,333.62 25110 444.01 421.81 485.08 25420 1,424.34 1,353.12 1,556.09 25111 359.60 341.62 392.86 25425 1,339.37 1,272.40 1,463.26 25112 431.55 409.97 471.47 25426 1,335.53 1,268.75 1,459.06 25115 961.22 913.16 1,050.13 25430 759.77 721.78 830.05 25116 811.24 770.68 886.28 25431 846.38 804.06 924.67 25118 440.54 418.51 481.29 25440 854.19 811.48 933.20 25119 581.34 552.27