1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 1 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 EFFECTIVE JANUARY 1, 2008-JUNE 30, 2008 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G0101 39.22 37.26 42.85 # G0268 32.06 30.46 35.03 G0102 22.62 21.49 24.71 G0270 26.58 25.25 29.04 # G0102 9.00 8.55 9.83 # G0270 26.13 24.82 28.54 G0104 145.31 138.04 158.75 G0271 14.96 14.21 16.34 # G0104 61.78 58.69 67.49 # G0271 14.50 13.78 15.85 G0105 423.47 402.30 462.65 G0275 14.50 13.78 15.85 # G0105 213.72 203.03 233.48 G0278 14.50 13.78 15.85 G0105 53 145.31 138.04 158.75 G0281 12.12 11.51 13.24 # G0105 53 61.78 58.69 67.49 G0283 12.12 11.51 13.24 G0106 210.38 199.86 229.84 G0288 270.65 257.12 295.69 G0106 TC 159.58 151.60 174.34 G0289 91.49 86.92 99.96 G0106 26 50.80 48.26 55.50 G0308 779.31 740.34 851.39 G0108 32.57 30.94 35.58 G0309 637.86 605.97 696.87 G0109 18.49 17.57 20.21 G0310 498.35 473.43 544.44 G0117 49.79 47.30 54.40 G0311 538.57 511.64 588.39 G0118 34.43 32.71 37.62 G0312 442.98 420.83 483.95 C G0120 206.30 195.99 225.39 G0313 347.13 329.77 379.24 C G0120 TC 155.49 147.72 169.88 G0314 475.05 451.30 519.00 G0120 26 50.80 48.26 55.50 G0315 390.34 370.82 426.44 G0121 423.47 402.30 462.65 G0316 302.75 287.61 330.75 # G0121 213.72 203.03 233.48 G0317 299.49 284.52 327.20 G0121 53 145.31 138.04 158.75 G0318 245.15 232.89 267.82 # G0121 53 61.78 58.69 67.49 G0319 191.21 181.65 208.90 G0124 27.14 25.78 29.65 G0320 604.72 574.48 660.65 G0127 20.81 19.77 22.74 G0321 426.64 405.31 466.11 # G0127 9.00 8.55 9.83 G0322 370.82 352.28 405.12 G0128 4.02 3.82 4.39 G0323 232.44 220.82 253.94 G0130 42.21 40.10 46.12 G0324 21.70 20.62 23.71 G0130 TC 31.17 29.61 34.05 G0325 12.80 12.16 13.98 G0130 26 11.04 10.49 12.06 G0326 14.84 14.10 16.22 G0141 27.14 25.78 29.65 G0327 8.27 7.86 9.04 G0166 186.13 176.82 203.34 G0329 9.12 8.66 9.96 G0168 96.76 91.92 105.71 G0332 89.44 84.97 97.72 # G0168 26.39 25.07 28.83 G0339 3,915.07 3,719.32 4,277.22 G0179 50.57 48.04 55.25 G0340 2,658.17 2,525.26 2,904.05 G0180 65.70 62.42 71.78 G0341 372.35 353.73 406.79 G0181 114.34 108.62 124.91 G0342 699.91 664.91 764.65 G0182 118.88 112.94 129.88 G0343 1,154.89 1,097.15 1,261.72 G0186 368.26 349.85 402.33 G0344 100.95 95.90 110.29 G0202 154.56 146.83 168.85 # G0344 70.53 67.00 77.05 G0202 TC 118.55 112.62 129.51 G0364 13.69 13.01 14.96 G0202 26 36.02 34.22 39.35 # G0364 9.60 9.12 10.49 G0204 174.46 165.74 190.60 C G0365 191.39 181.82 209.09 G0204 TC 129.44 122.97 141.42 C G0365 TC 178.37 169.45 194.87 G0204 26 45.02 42.77 49.19 G0365 26 13.02 12.37 14.23 G0206 139.25 132.29 152.13 G0366 26.01 24.71 28.42 G0206 TC 103.23 98.07 112.78 G0367 17.01 16.16 18.58 G0206 26 36.02 34.22 39.35 G0368 9.00 8.55 9.83 G0237 16.10 15.30 17.60 G0372 16.27 15.46 17.78 G0238 17.01 16.16 18.58 # G0372 8.55 8.12 9.34 G0239 15.19 14.43 16.59 G0389 133.28 126.62 145.61 G0245 68.63 65.20 74.98 G0389 TC 102.99 97.84 112.52 # G0245 45.48 43.21 49.69 G0389 26 30.30 28.79 33.11 G0246 41.49 39.42 45.33 G0392 2,731.03 2,594.48 2,983.65 # G0246 23.33 22.16 25.48 # G0392 509.17 483.71 556.27 G0247 45.35 43.08 49.54 G0393 2,081.38 1,977.31 2,273.91 # G0247 26.28 24.97 28.72 # G0393 325.78 309.49 355.91 G0248 227.78 216.39 248.85 G0396 31.56 29.98 34.48 G0249 167.40 159.03 182.88 # G0396 29.74 28.25 32.49 G0250 9.85 9.36 10.76 G0397 61.63 58.55 67.33 G0268 51.58 49.00 56.35 # G0397 59.36 56.39 64.85 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 31146 PAGE 2 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G9041 24.87 23.63 27.17 10022 153.75 146.06 167.97 G9042 11.16 10.60 12.19 # 10022 65.67 62.39 71.75 G9043 11.16 10.60 12.19 10040 96.41 91.59 105.33 G9044 9.80 9.31 10.71 # 10040 83.24 79.08 90.94 M0064 41.56 39.48 45.40 10060 107.36 101.99 117.29 # M0064 17.50 16.63 19.12 # 10060 91.47 86.90 99.94 P3001 27.14 25.78 29.65 10061 181.61 172.53 198.41 Q0035 23.74 22.55 25.93 # 10061 161.18 153.12 176.09 Q0035 TC 15.19 14.43 16.59 10080 176.49 167.67 192.82 Q0035 26 8.55 8.12 9.34 # 10080 95.67 90.89 104.52 Q0091 45.98 43.68 50.23 10081 266.01 252.71 290.62 # Q0091 19.20 18.24 20.98 # 10081 161.13 153.07 176.03 Q0092 18.49 17.57 20.21 10120 140.32 133.30 153.30 R0070 191.66 182.08 209.39 # 10120 90.39 85.87 98.75 R0075 191.66 182.08 209.39 10121 265.06 251.81 289.58 0016T 368.26 349.85 402.33 # 10121 183.79 174.60 200.79 0030T 26.73 25.39 29.20 10140 151.93 144.33 165.98 0067T 486.75 462.41 531.77 # 10140 118.79 112.85 129.78 C 0067T TC 223.47 212.30 244.15 10160 125.16 118.90 136.74 0067T 26 67.40 64.03 73.63 # 10160 96.10 91.30 105.00 0073T 712.55 676.92 778.46 10180 232.56 220.93 254.07 0075T 1,184.23 1,125.02 1,293.77 # 10180 176.71 167.87 193.05 0075T 26 904.50 859.28 988.17 11000 52.85 50.21 57.74 0076T 390.79 371.25 426.94 # 11000 31.96 30.36 34.91 0076T 26 90.45 85.93 98.82 11001 22.08 20.98 24.13 0078T 1,477.22 1,403.36 1,613.86 # 11001 16.18 15.37 17.68 0079T 142.67 135.54 155.87 11004 560.45 532.43 612.29 0080T 260.47 247.45 284.57 11005 741.06 704.01 809.61 0081T 26.04 24.74 28.45 11006 699.77 664.78 764.50 0144T 321.60 305.52 351.35 11008 270.05 256.55 295.03 C 0144T TC 117.74 111.85 128.63 11010 478.73 454.79 523.01 0144T 26 60.30 57.29 65.88 # 11010 280.79 266.75 306.76 0145T 477.38 453.51 521.54 11011 542.06 514.96 592.20 C 0145T TC 349.14 331.68 381.43 # 11011 295.99 281.19 323.37 0145T 26 75.38 71.61 82.35 11012 757.78 719.89 827.87 0146T 633.15 601.49 691.71 # 11012 435.89 414.10 476.22 C 0146T TC 349.14 331.68 381.43 11040 46.68 44.35 51.00 0146T 26 100.50 95.48 109.80 # 11040 27.61 26.23 30.16 0147T 633.15 601.49 691.71 11041 55.66 52.88 60.81 C 0147T TC 349.14 331.68 381.43 # 11041 36.14 34.33 39.48 0147T 26 100.50 95.48 109.80 11042 75.65 71.87 82.65 0148T 633.15 601.49 691.71 # 11042 47.50 45.13 51.90 C 0148T TC 349.14 331.68 381.43 11043 273.05 259.40 298.31 0148T 26 100.50 95.48 109.80 # 11043 234.91 223.16 256.63 0149T 633.15 601.49 691.71 11044 368.90 350.46 403.03 C 0149T TC 349.14 331.68 381.43 # 11044 324.41 308.19 354.42 0149T 26 100.50 95.48 109.80 11055 47.60 45.22 52.00 0150T 633.15 601.49 691.71 # 11055 23.08 21.93 25.22 C 0150T TC 349.14 331.68 381.43 11056 58.24 55.33 63.63 0150T 26 100.50 95.48 109.80 # 11056 32.36 30.74 35.35 0151T 201.00 190.95 219.59 11057 70.12 66.61 76.60 C 0151T TC 117.74 111.85 128.63 # 11057 42.42 40.30 46.35 0151T 26 60.30 57.29 65.88 11100 99.97 94.97 109.22 0159T 19.46 18.49 21.26 # 11100 46.40 44.08 50.69 0159T TC 16.23 15.42 17.73 11101 31.73 30.14 34.66 0159T 26 3.23 3.07 3.53 # 11101 23.56 22.38 25.74 0171T 815.27 774.51 890.69 11200 80.38 76.36 87.81 0172T 407.64 387.26 445.35 # 11200 66.76 63.42 72.93 0177T 1,348.33 1,280.91 1,473.05 11201 18.24 17.33 19.93 10021 146.24 138.93 159.77 # 11201 16.42 15.60 17.94 # 10021 68.61 65.18 74.96 11300 68.32 64.90 74.64 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 31146 PAGE 3 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11300 28.37 26.95 30.99 11451 464.08 440.88 507.01 11301 90.54 86.01 98.91 # 11451 293.38 278.71 320.52 # 11301 48.32 45.90 52.79 11462 349.50 332.03 381.83 11302 107.60 102.22 117.55 # 11462 214.21 203.50 234.03 # 11302 59.47 56.50 64.98 11463 473.04 449.39 516.80 11303 127.71 121.32 139.52 # 11463 297.34 282.47 324.84 # 11303 70.05 66.55 76.53 11470 380.19 361.18 415.36 11305 69.30 65.84 75.72 # 11470 252.17 239.56 275.49 # 11305 36.61 34.78 40.00 11471 487.44 463.07 532.53 11306 94.02 89.32 102.72 # 11471 318.56 302.63 348.02 # 11306 54.98 52.23 60.06 11600 180.55 171.52 197.25 11307 109.62 104.14 119.76 # 11600 106.10 100.80 115.92 # 11307 63.76 60.57 69.66 11601 213.93 203.23 233.71 11308 125.21 118.95 136.79 # 11601 136.30 129.49 148.91 # 11308 77.99 74.09 85.20 11602 232.93 221.28 254.47 11310 83.45 79.28 91.17 # 11602 148.03 140.63 161.72 # 11310 41.23 39.17 45.05 11603 263.67 250.49 288.06 11311 103.06 97.91 112.60 # 11603 174.69 165.96 190.85 # 11311 59.93 56.93 65.47 11604 290.91 276.36 317.81 11312 119.84 113.85 130.93 # 11604 191.03 181.48 208.70 # 11312 68.99 65.54 75.37 11606 402.61 382.48 439.85 11313 150.81 143.27 164.76 # 11606 280.94 266.89 306.92 # 11313 92.70 88.07 101.28 11620 181.98 172.88 198.81 11400 120.60 114.57 131.76 # 11620 107.07 101.72 116.98 # 11400 73.83 70.14 80.66 11621 215.69 204.91 235.65 11401 143.18 136.02 156.42 # 11621 138.06 131.16 150.83 # 11401 96.42 91.60 105.34 11622 242.83 230.69 265.29 11402 158.75 150.81 173.43 # 11622 158.39 150.47 173.04 # 11402 105.63 100.35 115.40 11623 282.63 268.50 308.78 11403 181.27 172.21 198.04 # 11623 193.65 183.97 211.57 # 11403 134.06 127.36 146.46 11624 319.14 303.18 348.66 11404 205.73 195.44 224.76 # 11624 221.07 210.02 241.52 # 11404 148.08 140.68 161.78 11626 392.23 372.62 428.51 11406 281.76 267.67 307.82 # 11626 281.46 267.39 307.50 # 11406 216.84 206.00 236.90 11640 190.19 180.68 207.78 11420 119.60 113.62 130.66 # 11640 114.83 109.09 125.45 # 11420 80.10 76.10 87.52 11641 230.63 219.10 251.97 11421 151.82 144.23 165.86 # 11641 150.73 143.19 164.67 # 11421 106.42 101.10 116.27 11642 264.80 251.56 289.29 11422 169.49 161.02 185.17 # 11642 176.72 167.88 193.06 # 11422 127.72 121.33 139.53 11643 309.80 294.31 338.46 11423 197.01 187.16 215.23 # 11643 219.00 208.05 239.26 # 11423 147.98 140.58 161.67 11644 383.70 364.52 419.20 11424 225.14 213.88 245.96 # 11644 273.83 260.14 299.16 # 11424 170.66 162.13 186.45 11646 501.79 476.70 548.21 11426 316.46 300.64 345.74 # 11646 386.93 367.58 422.72 # 11426 256.08 243.28 279.77 11719 20.68 19.65 22.60 11440 133.68 127.00 146.05 # 11719 9.33 8.86 10.19 # 11440 97.81 92.92 106.86 11720 30.59 29.06 33.42 11441 163.79 155.60 178.94 # 11720 16.97 16.12 18.54 # 11441 125.66 119.38 137.29 11721 43.60 41.42 47.63 11442 183.56 174.38 200.54 # 11721 29.07 27.62 31.76 # 11442 139.06 132.11 151.93 11730 96.68 91.85 105.63 11443 219.44 208.47 239.74 # 11730 59.45 56.48 64.95 # 11443 170.87 162.33 186.68 11732 44.39 42.17 48.50 11444 274.53 260.80 299.92 # 11732 30.32 28.80 33.12 # 11444 217.33 206.46 237.43 11740 44.83 42.59 48.98 11446 364.77 346.53 398.51 # 11740 32.12 30.51 35.09 # 11446 303.94 288.74 332.05 11750 207.18 196.82 226.34 11450 351.74 334.15 384.27 # 11750 173.58 164.90 189.64 # 11450 221.89 210.80 242.42 11752 293.20 278.54 320.32 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 4 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11752 263.69 250.51 288.09 12013 174.67 165.94 190.83 11755 131.96 125.36 144.16 # 12013 117.46 111.59 128.33 # 11755 84.74 80.50 92.58 12014 204.39 194.17 223.30 11760 199.52 189.54 217.97 # 12014 140.37 133.35 153.35 # 11760 135.96 129.16 148.53 12015 256.21 243.40 279.91 11762 262.81 249.67 287.12 # 12015 175.40 166.63 191.62 # 11762 204.70 194.47 223.64 12016 302.40 287.28 330.37 11765 128.87 122.43 140.79 # 12016 213.41 202.74 233.15 # 11765 67.58 64.20 73.83 12017 258.16 245.25 282.04 11770 260.47 247.45 284.57 12018 309.60 294.12 338.24 # 11770 171.49 162.92 187.36 12020 272.64 259.01 297.86 11771 512.25 486.64 559.64 # 12020 185.47 176.20 202.63 # 11771 392.40 372.78 428.70 12021 156.52 148.69 170.99 11772 634.84 603.10 693.57 # 12021 135.18 128.42 147.68 # 11772 523.16 497.00 571.55 12031 221.65 210.57 242.16 11900 54.31 51.59 59.33 # 12031 143.57 136.39 156.85 # 11900 29.34 27.87 32.05 12032 297.80 282.91 325.35 11901 66.43 63.11 72.58 # 12032 184.75 175.51 201.84 # 11901 45.55 43.27 49.76 12034 288.04 273.64 314.69 11920 201.37 191.30 220.00 # 12034 189.07 179.62 206.56 # 11920 113.75 108.06 124.27 12035 371.42 352.85 405.78 11921 227.30 215.94 248.33 # 12035 229.77 218.28 251.02 # 11921 134.23 127.52 146.65 12036 408.98 388.53 446.81 11922 66.13 62.82 72.24 # 12036 268.69 255.26 293.55 # 11922 30.27 28.76 33.07 12037 459.46 436.49 501.96 11950 77.18 73.32 84.32 # 12037 312.37 296.75 341.26 # 11950 48.13 45.72 52.58 12041 235.30 223.54 257.07 11951 99.76 94.77 108.99 # 12041 155.39 147.62 169.76 # 11951 64.80 61.56 70.79 12042 278.14 264.23 303.86 11952 143.38 136.21 156.64 # 12042 183.25 174.09 200.20 # 11952 97.07 92.22 106.05 12044 314.85 299.11 343.98 11954 169.17 160.71 184.82 # 12044 199.54 189.56 217.99 # 11954 110.60 105.07 120.83 12045 374.68 355.95 409.34 11960 904.29 859.08 987.94 # 12045 239.39 227.42 261.53 11970 588.41 558.99 642.84 12046 442.63 420.50 483.58 11971 497.82 472.93 543.87 # 12046 281.00 266.95 306.99 # 11971 300.33 285.31 328.11 12047 473.27 449.61 517.05 11976 147.30 139.94 160.93 # 12047 312.10 296.50 340.98 # 11976 95.55 90.77 104.39 12051 260.99 247.94 285.13 11980 104.89 99.65 114.60 # 12051 170.19 161.68 185.93 # 11980 79.01 75.06 86.32 12052 286.99 272.64 313.54 11981 137.24 130.38 149.94 # 12052 194.37 184.65 212.35 # 11981 84.13 79.92 91.91 12053 313.58 297.90 342.59 11982 157.78 149.89 172.37 # 12053 200.54 190.51 219.09 # 11982 102.39 97.27 111.86 12054 335.58 318.80 366.62 11983 234.69 222.96 256.40 # 12054 214.81 204.07 234.68 # 11983 186.11 176.80 203.32 12055 408.30 387.89 446.07 12001 149.29 141.83 163.10 # 12055 265.75 252.46 290.33 # 12001 98.90 93.96 108.05 12056 505.11 479.85 551.83 12002 158.62 150.69 173.29 # 12056 330.78 314.24 361.38 # 12002 110.95 105.40 121.21 12057 542.66 515.53 592.86 12004 185.75 176.46 202.93 # 12057 378.76 359.82 413.79 # 12004 129.90 123.41 141.92 13100 310.95 295.40 339.71 12005 230.88 219.34 252.24 # 13100 226.96 215.61 247.95 # 12005 160.97 152.92 175.86 13101 386.43 367.11 422.18 12006 286.71 272.37 313.23 # 13101 274.29 260.58 299.67 # 12006 203.63 193.45 222.47 13102 104.73 99.49 114.41 12007 322.23 306.12 352.04 # 13102 72.50 68.88 79.21 # 12007 233.70 222.02 255.32 13120 322.34 306.22 352.15 12011 159.26 151.30 174.00 # 13120 236.08 224.28 257.92 # 12011 102.51 97.38 111.99 13121 422.95 401.80 462.07 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 31146 PAGE 5 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 13121 306.73 291.39 335.10 15120 922.30 876.19 1,007.62 13122 120.71 114.67 131.87 # 15120 767.04 728.69 837.99 # 13122 82.57 78.44 90.21 15121 285.35 271.08 311.74 13131 354.37 336.65 387.15 # 15121 176.39 167.57 192.71 # 13131 267.66 254.28 292.42 15130 695.60 660.82 759.94 13132 550.27 522.76 601.17 # 15130 561.67 533.59 613.63 # 13132 444.03 421.83 485.10 15131 98.35 93.43 107.44 13133 162.85 154.71 177.92 # 15131 84.73 80.49 92.56 # 13133 127.89 121.50 139.73 15135 861.30 818.24 940.98 13150 362.42 344.30 395.95 # 15135 766.41 728.09 837.30 # 13150 268.89 255.45 293.77 15136 93.93 89.23 102.61 13151 400.37 380.35 437.40 # 15136 85.76 81.47 93.69 # 13151 310.47 294.95 339.19 15150 714.39 678.67 780.47 13152 542.77 515.63 592.97 # 15150 639.48 607.51 698.64 # 13152 415.20 394.44 453.61 15151 128.56 122.13 140.45 13153 181.57 172.49 198.36 # 15151 113.57 107.89 124.07 # 13153 140.26 133.25 153.24 15152 157.86 149.97 172.47 13160 786.51 747.18 859.26 # 15152 141.97 134.87 155.10 14000 639.22 607.26 698.35 15155 737.12 700.26 805.30 # 14000 519.36 493.39 567.40 # 15155 687.18 652.82 750.74 14001 826.22 784.91 902.65 15156 169.18 160.72 184.83 # 14001 692.74 658.10 756.82 # 15156 157.38 149.51 171.94 14020 711.98 676.38 777.84 15157 188.43 179.01 205.86 # 14020 593.49 563.82 648.39 # 15157 171.64 163.06 187.52 14021 927.25 880.89 1,013.02 15170 405.16 384.90 442.64 # 14021 801.94 761.84 876.12 # 15170 339.78 322.79 371.21 14040 746.45 709.13 815.50 15171 89.28 84.82 97.54 # 14040 637.49 605.62 696.46 # 15171 84.74 80.50 92.58 14041 1,015.58 964.80 1,109.52 15175 531.06 504.51 580.19 # 14041 875.75 831.96 956.75 # 15175 468.41 444.99 511.74 14060 758.84 720.90 829.04 15176 143.84 136.65 157.15 # 14060 671.22 637.66 733.31 # 15176 135.67 128.89 148.22 14061 1,102.76 1,047.62 1,204.76 15200 784.30 745.09 856.85 # 14061 949.31 901.84 1,037.12 # 15200 630.84 599.30 689.20 14300 1,061.36 1,008.29 1,159.53 15201 156.26 148.45 170.72 # 14300 924.25 878.04 1,009.75 # 15201 76.81 72.97 83.92 14350 741.01 703.96 809.55 15220 751.69 714.11 821.23 15002 335.11 318.35 366.10 # 15220 609.13 578.67 665.47 # 15002 220.25 209.24 240.63 15221 145.00 137.75 158.41 15003 72.26 68.65 78.95 # 15221 71.00 67.45 77.57 # 15003 43.21 41.05 47.21 15240 889.82 845.33 972.13 15004 401.90 381.81 439.08 # 15240 767.70 729.32 838.72 # 15004 272.06 258.46 297.23 15241 185.70 176.42 202.88 15005 119.50 113.53 130.56 # 15241 111.70 106.12 122.04 # 15005 87.26 82.90 95.34 15260 948.11 900.70 1,035.81 15040 270.69 257.16 295.73 # 15260 827.35 785.98 903.88 # 15040 127.23 120.87 139.00 15261 213.61 202.93 233.37 15050 536.50 509.68 586.13 # 15261 142.79 135.65 156.00 # 15050 436.17 414.36 476.51 15300 329.14 312.68 359.58 15100 890.22 845.71 972.57 # 15300 277.84 263.95 303.54 # 15100 711.79 676.20 777.63 15301 60.42 57.40 66.01 15101 208.57 198.14 227.86 # 15301 55.88 53.09 61.05 # 15101 113.68 108.00 124.20 15320 374.36 355.64 408.99 15110 864.12 820.91 944.05 # 15320 317.61 301.73 346.99 # 15110 726.56 690.23 793.76 15321 90.63 86.10 99.02 15111 122.28 116.17 133.60 # 15321 84.27 80.06 92.07 # 15111 105.03 99.78 114.75 15330 307.06 291.71 335.47 15115 847.73 805.34 926.14 # 15330 254.39 241.67 277.92 # 15115 748.76 711.32 818.02 15331 60.87 57.83 66.50 15116 161.28 153.22 176.20 # 15331 56.79 53.95 62.04 # 15116 143.12 135.96 156.35 15335 329.61 313.13 360.10 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 31146 PAGE 6 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 15335 276.50 262.68 302.08 15770 642.09 609.99 701.49 15336 88.83 84.39 97.05 15775 316.85 301.01 346.16 # 15336 81.11 77.05 88.61 # 15775 212.43 201.81 232.08 15340 319.17 303.21 348.69 15776 448.97 426.52 490.50 # 15340 267.42 254.05 292.16 # 15776 329.11 312.65 359.55 15341 47.58 45.20 51.98 15780 835.84 794.05 913.16 # 15341 27.15 25.79 29.66 # 15780 654.70 621.97 715.27 15360 363.01 344.86 396.59 15781 536.68 509.85 586.33 # 15360 301.72 286.63 329.62 # 15781 432.71 411.07 472.73 15361 69.21 65.75 75.61 15782 585.29 556.03 639.43 # 15361 62.40 59.28 68.17 # 15782 425.03 403.78 464.35 15365 361.21 343.15 394.62 15783 496.31 471.49 542.21 # 15365 305.37 290.10 333.62 # 15783 368.28 349.87 402.35 15366 87.26 82.90 95.34 15786 240.21 228.20 262.43 # 15366 80.45 76.43 87.89 # 15786 133.52 126.84 145.87 15400 372.93 354.28 407.42 15787 56.41 53.59 61.63 # 15400 345.24 327.98 377.18 # 15787 18.27 17.36 19.96 15401 105.36 100.09 115.10 15788 443.89 421.70 484.96 # 15401 57.24 54.38 62.54 # 15788 240.04 228.04 262.25 15420 420.13 399.12 458.99 15789 575.62 546.84 628.87 # 15420 368.83 350.39 402.95 # 15789 419.44 398.47 458.24 15421 115.60 109.82 126.29 15792 434.35 412.63 474.52 # 15421 84.27 80.06 92.07 # 15792 274.54 260.81 299.93 15430 535.76 508.97 585.32 15793 466.40 443.08 509.54 # 15430 516.69 490.86 564.49 # 15793 350.18 332.67 382.57 15570 879.53 835.55 960.88 15819 711.57 675.99 777.39 # 15570 689.76 655.27 753.56 15820 529.06 502.61 578.00 15572 824.39 783.17 900.65 # 15820 470.04 446.54 513.52 # 15572 684.56 650.33 747.88 15821 563.25 535.09 615.35 15574 889.10 844.65 971.35 # 15821 496.97 472.12 542.94 # 15574 743.82 706.63 812.62 15822 420.74 399.70 459.66 15576 792.89 753.25 866.24 # 15822 364.44 346.22 398.15 # 15576 655.78 622.99 716.44 15823 646.02 613.72 705.78 15600 370.43 351.91 404.70 # 15823 584.73 555.49 638.81 # 15600 209.27 198.81 228.63 15830 1,132.99 1,076.34 1,237.79 15610 330.55 314.02 361.12 15832 874.03 830.33 954.88 # 15610 244.74 232.50 267.38 15833 814.65 773.92 890.01 15620 461.79 438.70 504.51 15834 831.33 789.76 908.22 # 15620 314.69 298.96 343.80 15835 849.10 806.65 927.65 15630 469.78 446.29 513.23 15836 717.20 681.34 783.54 # 15630 341.30 324.24 372.88 15837 757.59 719.71 827.67 15650 503.43 478.26 550.00 # 15837 664.98 631.73 726.49 # 15650 371.31 352.74 405.65 15838 562.64 534.51 614.69 15731 1,075.55 1,021.77 1,175.04 15839 823.09 781.94 899.23 # 15731 959.33 911.36 1,048.06 # 15839 692.80 658.16 756.88 15732 1,496.99 1,422.14 1,635.46 15840 988.25 938.84 1,079.67 # 15732 1,283.61 1,219.43 1,402.34 15841 1,629.30 1,547.84 1,780.02 15734 1,539.75 1,462.76 1,682.17 15842 2,578.80 2,449.86 2,817.34 # 15734 1,322.29 1,256.18 1,444.61 15845 918.26 872.35 1,003.20 15736 1,390.59 1,321.06 1,519.22 15851 100.68 95.65 110.00 # 15736 1,144.98 1,087.73 1,250.89 # 15851 44.38 42.16 48.48 15738 1,469.73 1,396.24 1,605.68 15852 46.28 43.97 50.57 # 15738 1,246.37 1,184.05 1,361.66 15860 109.39 103.92 119.51 15740 963.36 915.19 1,052.47 15920 566.61 538.28 619.02 # 15740 826.25 784.94 902.68 15922 730.76 694.22 798.35 15750 897.89 853.00 980.95 15931 644.79 612.55 704.43 15756 2,324.37 2,208.15 2,539.37 15933 799.37 759.40 873.31 15757 2,315.73 2,199.94 2,529.93 15934 889.74 845.25 972.04 15758 2,311.02 2,195.47 2,524.79 15935 1,056.29 1,003.48 1,154.00 15760 830.44 788.92 907.26 15936 868.91 825.46 949.28 # 15760 691.07 656.52 755.00 15937 1,018.28 967.37 1,112.48 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 31146 PAGE 7 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 15940 668.27 634.86 730.09 17276 273.18 259.52 298.45 15941 888.35 843.93 970.52 # 17276 200.54 190.51 219.09 15944 862.94 819.79 942.76 17280 133.64 126.96 146.00 15945 954.21 906.50 1,042.48 # 17280 85.06 80.81 92.93 15946 1,573.61 1,494.93 1,719.17 17281 168.31 159.89 183.87 15950 556.46 528.64 607.94 # 17281 117.92 112.02 128.82 15951 792.93 753.28 866.27 17282 194.73 184.99 212.74 15952 822.41 781.29 898.48 # 17282 136.16 129.35 148.75 15953 918.51 872.58 1,003.47 17283 234.90 223.16 256.63 15956 1,114.17 1,058.46 1,217.23 # 17283 170.43 161.91 186.20 15958 1,140.25 1,083.24 1,245.73 17284 273.54 259.86 298.84 16000 69.45 65.98 75.88 # 17284 202.72 192.58 221.47 # 16000 44.93 42.68 49.08 17286 347.38 330.01 379.51 16020 84.89 80.65 92.75 # 17286 275.19 261.43 300.64 # 16020 56.29 53.48 61.50 17311 710.67 675.14 776.41 16025 146.75 139.41 160.32 # 17311 362.91 344.76 396.47 # 16025 112.24 106.63 122.62 17312 432.49 410.87 472.50 16030 177.22 168.36 193.61 # 17312 193.24 183.58 211.12 # 16030 129.10 122.65 141.05 17313 650.13 617.62 710.26 16035 209.26 198.80 228.62 # 17313 325.97 309.67 356.12 16036 83.03 78.88 90.71 17314 399.83 379.84 436.82 17000 76.83 72.99 83.94 # 17314 178.74 169.80 195.27 # 17000 51.86 49.27 56.66 17315 83.28 79.12 90.99 17003 7.70 7.32 8.42 # 17315 51.05 48.50 55.78 # 17003 4.98 4.73 5.44 17340 44.57 42.34 48.69 17004 174.68 165.95 190.84 # 17340 45.02 42.77 49.19 # 17004 134.28 127.57 146.71 17360 127.25 120.89 139.02 17106 384.09 364.89 419.62 # 17360 95.02 90.27 103.81 # 17106 323.25 307.09 353.15 19000 120.52 114.49 131.66 17107 663.54 630.36 724.91 # 19000 45.16 42.90 49.34 # 17107 577.73 548.84 631.17 19001 27.35 25.98 29.88 17108 891.20 846.64 973.64 # 19001 22.35 21.23 24.41 # 17108 798.58 758.65 872.45 19020 439.56 417.58 480.22 17110 102.23 97.12 111.69 # 19020 275.22 261.46 300.68 # 17110 60.92 57.87 66.55 19030 182.27 173.16 199.13 17111 123.55 117.37 134.98 # 19030 80.12 76.11 87.53 # 17111 78.15 74.24 85.38 19100 144.15 136.94 157.48 17250 77.09 73.24 84.23 # 19100 66.51 63.18 72.66 # 17250 35.78 33.99 39.09 19101 326.32 310.00 356.50 17260 94.67 89.94 103.43 # 19101 208.74 198.30 228.05 # 17260 65.16 61.90 71.19 19102 240.13 228.12 262.34 17261 136.36 129.54 148.97 # 19102 104.84 99.60 114.54 # 17261 86.42 82.10 94.42 19103 629.13 597.67 687.32 17262 165.04 156.79 180.31 # 19103 193.74 184.05 211.66 # 17262 110.10 104.60 120.29 19105 2,250.35 2,137.83 2,458.50 17263 181.59 172.51 198.39 # 19105 184.21 175.00 201.25 # 17263 121.21 115.15 132.42 19110 439.98 417.98 480.68 17264 196.10 186.30 214.25 # 19110 306.05 290.75 334.36 # 17264 129.36 122.89 141.32 19112 425.18 403.92 464.51 17266 221.65 210.57 242.16 # 19112 278.08 264.18 303.81 # 17266 149.01 141.56 162.79 19120 446.38 424.06 487.67 17270 142.42 135.30 155.60 # 19120 373.74 355.05 408.31 # 17270 92.94 88.29 101.53 19125 491.22 466.66 536.66 17271 155.51 147.73 169.89 # 19125 414.04 393.34 452.34 # 17271 104.66 99.43 114.34 19126 154.40 146.68 168.68 17272 178.01 169.11 194.48 19260 1,169.05 1,110.60 1,277.19 # 17272 121.26 115.20 132.48 19271 1,617.74 1,536.85 1,767.38 17273 197.85 187.96 216.15 19272 1,781.16 1,692.10 1,945.92 # 17273 136.10 129.30 148.70 19290 177.03 168.18 193.41 17274 234.79 223.05 256.51 # 19290 66.25 62.94 72.38 # 17274 166.69 158.36 182.11 19291 76.25 72.44 83.31 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 31146 PAGE 8 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 19291 32.67 31.04 35.70 # 20225 121.75 115.66 133.01 19295 113.38 107.71 123.87 20240 231.96 220.36 253.41 19296 4,939.84 4,692.85 5,396.78 20245 629.21 597.75 687.41 # 19296 200.56 190.53 219.11 20250 375.92 357.12 410.69 19297 90.02 85.52 98.35 20251 418.39 397.47 457.09 19298 1,680.94 1,596.89 1,836.42 20500 129.31 122.84 141.27 # 19298 326.21 309.90 356.39 # 20500 102.07 96.97 111.52 19300 549.52 522.04 600.35 20501 147.75 140.36 161.41 # 19300 369.28 350.82 403.44 # 20501 39.70 37.72 43.38 19301 558.02 530.12 609.64 20520 197.69 187.81 215.98 19302 827.51 786.13 904.05 # 20520 145.48 138.21 158.94 19303 859.15 816.19 938.62 20525 508.53 483.10 555.57 19304 527.47 501.10 576.27 # 20525 249.30 236.84 272.37 19305 1,030.51 978.98 1,125.83 20526 77.63 73.75 84.81 19306 1,077.27 1,023.41 1,176.92 # 20526 58.10 55.20 63.48 19307 1,082.95 1,028.80 1,183.12 20550 59.57 56.59 65.08 19316 766.05 727.75 836.91 # 20550 40.96 38.91 44.75 19318 1,131.19 1,074.63 1,235.82 20551 58.79 55.85 64.23 19324 472.68 449.05 516.41 # 20551 42.90 40.76 46.87 19325 635.22 603.46 693.98 20552 54.16 51.45 59.17 19328 479.28 455.32 523.62 # 20552 34.64 32.91 37.85 19330 607.20 576.84 663.37 20553 60.64 57.61 66.25 19340 390.39 370.87 426.50 # 20553 38.39 36.47 41.94 19342 899.42 854.45 982.62 20555 322.58 306.45 352.42 19350 899.69 854.71 982.92 20600 55.61 52.83 60.75 # 19350 673.14 639.48 735.40 # 20600 40.63 38.60 44.39 19355 723.61 687.43 790.54 20605 60.49 57.47 66.09 # 19355 535.65 508.87 585.20 # 20605 41.88 39.79 45.76 19357 1,519.72 1,443.73 1,660.29 20610 77.26 73.40 84.41 19361 1,569.77 1,491.28 1,714.97 # 20610 50.02 47.52 54.65 19364 2,725.77 2,589.48 2,977.90 20612 59.68 56.70 65.21 19366 1,353.55 1,285.87 1,478.75 # 20612 43.34 41.17 47.35 19367 1,786.72 1,697.38 1,951.99 20615 228.31 216.89 249.42 19368 2,196.37 2,086.55 2,399.53 # 20615 161.12 153.06 176.02 19369 2,021.41 1,920.34 2,208.39 20650 198.20 188.29 216.53 19370 667.80 634.41 729.57 # 20650 156.89 149.05 171.41 19371 770.02 731.52 841.25 20660 262.65 249.52 286.95 19380 751.97 714.37 821.53 # 20660 229.51 218.03 250.73 19396 213.25 202.59 232.98 20661 466.22 442.91 509.35 # 19396 137.44 130.57 150.16 20662 471.76 448.17 515.40 20000 207.23 196.87 226.40 20663 447.18 424.82 488.54 # 20000 156.83 148.99 171.34 20664 739.52 702.54 807.92 20005 301.89 286.80 329.82 20665 132.60 125.97 144.87 # 20005 236.06 224.26 257.90 # 20665 105.36 100.09 115.10 20100 583.45 554.28 637.42 20670 482.97 458.82 527.64 20101 411.40 390.83 449.45 # 20670 156.55 148.72 171.03 # 20101 198.48 188.56 216.84 20680 609.29 578.83 665.65 20102 481.56 457.48 526.10 # 20680 401.35 381.28 438.47 # 20102 239.13 227.17 261.25 20690 490.13 465.62 535.46 20103 582.71 553.57 636.61 20692 901.74 856.65 985.15 # 20103 350.72 333.18 383.16 20693 466.70 443.37 509.88 20150 910.79 865.25 995.04 20694 453.09 430.44 495.01 20200 197.70 187.82 215.99 # 20694 341.86 324.77 373.49 # 20200 91.46 86.89 99.92 20802 2,379.97 2,260.97 2,600.12 20205 268.26 254.85 293.08 20805 3,133.92 2,977.22 3,423.80 # 20205 144.78 137.54 158.17 20808 4,067.56 3,864.18 4,443.81 20206 302.86 287.72 330.88 20816 2,488.33 2,363.91 2,718.50 # 20206 64.06 60.86 69.99 20822 2,189.35 2,079.88 2,391.86 20220 211.86 201.27 231.46 20824 2,459.54 2,336.56 2,687.04 # 20220 80.20 76.19 87.62 20827 2,236.06 2,124.26 2,442.90 20225 900.35 855.33 983.63 20838 2,347.64 2,230.26 2,564.80 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 31146 PAGE 9 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 20900 633.48 601.81 692.08 # 21076 867.89 824.50 948.18 # 20900 472.76 449.12 516.49 21077 2,458.04 2,335.14 2,685.41 20902 613.78 583.09 670.55 # 21077 2,187.46 2,078.09 2,389.80 20910 433.83 412.14 473.96 21079 1,689.31 1,604.84 1,845.57 20912 490.70 466.17 536.10 # 21079 1,457.32 1,384.45 1,592.12 20920 405.33 385.06 442.82 21080 1,922.42 1,826.30 2,100.25 20922 604.67 574.44 660.61 # 21080 1,644.12 1,561.91 1,796.20 # 20922 485.73 461.44 530.66 21081 1,751.83 1,664.24 1,913.88 20924 510.98 485.43 558.24 # 21081 1,492.14 1,417.53 1,630.16 20926 437.64 415.76 478.12 21082 1,608.75 1,528.31 1,757.56 20931 113.63 107.95 124.14 # 21082 1,376.30 1,307.49 1,503.61 20937 172.65 164.02 188.62 21083 1,534.15 1,457.44 1,676.06 20938 187.99 178.59 205.38 # 21083 1,273.10 1,209.45 1,390.87 20950 302.16 287.05 330.11 21084 1,749.80 1,662.31 1,911.66 # 20950 93.32 88.65 101.95 # 21084 1,462.87 1,389.73 1,598.19 20955 2,532.23 2,405.62 2,766.46 21085 701.64 666.56 766.54 20956 2,685.91 2,551.61 2,934.35 # 21085 589.96 560.46 644.53 20957 2,503.50 2,378.33 2,735.08 21086 1,824.74 1,733.50 1,993.53 20962 2,673.43 2,539.76 2,920.72 # 21086 1,625.43 1,544.16 1,775.78 20969 2,818.22 2,677.31 3,078.91 21087 1,808.06 1,717.66 1,975.31 20970 2,816.57 2,675.74 3,077.10 # 21087 1,613.30 1,532.64 1,762.54 20972 2,525.51 2,399.23 2,759.11 21100 769.94 731.44 841.16 20973 2,716.53 2,580.70 2,967.81 # 21100 404.02 383.82 441.39 20974 63.14 59.98 68.98 21110 739.96 702.96 808.40 # 20974 48.61 46.18 53.11 # 21110 637.36 605.49 696.31 20975 179.45 170.48 196.05 21116 185.41 176.14 202.56 20979 57.03 54.18 62.31 # 21116 42.85 40.71 46.82 # 20979 37.05 35.20 40.48 21120 653.41 620.74 713.85 20982 4,582.80 4,353.66 5,006.71 # 21120 514.94 489.19 562.57 # 20982 405.12 384.86 442.59 21121 761.30 723.24 831.73 20985 148.10 140.70 161.81 # 21121 648.71 616.27 708.71 21010 721.17 685.11 787.88 21122 722.95 686.80 789.82 21015 429.86 408.37 469.63 21123 843.14 800.98 921.13 21025 993.32 943.65 1,085.20 21125 3,106.09 2,950.79 3,393.41 # 21025 841.23 799.17 919.05 # 21125 733.95 697.25 801.84 21026 592.48 562.86 647.29 21127 3,380.24 3,211.23 3,692.91 # 21026 491.69 467.11 537.18 # 21127 862.83 819.69 942.64 21029 749.36 711.89 818.67 21137 741.64 704.56 810.24 # 21029 626.78 595.44 684.76 21138 895.68 850.90 978.54 21030 492.53 467.90 538.09 21139 969.29 920.83 1,058.95 # 21030 406.27 385.96 443.85 21141 1,330.43 1,263.91 1,453.50 21031 381.23 362.17 416.50 21142 1,296.98 1,232.13 1,416.95 # 21031 290.88 276.34 317.79 21143 1,372.37 1,303.75 1,499.31 21032 388.95 369.50 424.93 21145 1,530.20 1,453.69 1,671.74 # 21032 286.35 272.03 312.83 21146 1,516.24 1,440.43 1,656.49 21034 1,334.82 1,268.08 1,458.29 21147 1,640.55 1,558.52 1,792.30 # 21034 1,174.10 1,115.40 1,282.71 21150 1,749.93 1,662.43 1,911.79 21040 494.35 469.63 540.07 21151 1,868.67 1,775.24 2,041.53 # 21040 398.10 378.20 434.93 21154 2,098.20 1,993.29 2,292.28 21044 874.05 830.35 954.90 21155 2,397.32 2,277.45 2,619.07 21045 1,209.34 1,148.87 1,321.20 21159 2,774.19 2,635.48 3,030.80 21046 1,080.56 1,026.53 1,180.51 21160 2,928.20 2,781.79 3,199.06 21047 1,300.00 1,235.00 1,420.25 21172 1,722.46 1,636.34 1,881.79 21048 1,098.19 1,043.28 1,199.77 21175 2,039.23 1,937.27 2,227.86 21049 1,248.20 1,185.79 1,363.66 21179 1,455.51 1,382.73 1,590.14 21050 852.47 809.85 931.33 21180 1,648.92 1,566.47 1,801.44 21060 785.46 746.19 858.12 21181 723.65 687.47 790.59 21070 642.82 610.68 702.28 21182 2,007.25 1,906.89 2,192.92 21073 380.13 361.12 415.29 21183 2,299.77 2,184.78 2,512.50 # 21073 235.31 223.54 257.07 21184 2,386.50 2,267.18 2,607.26 21076 996.82 946.98 1,089.03 21188 1,642.54 1,560.41 1,794.47 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 31146 PAGE 10 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21193 1,235.63 1,173.85 1,349.93 21345 801.89 761.80 876.07 21194 1,407.40 1,337.03 1,537.58 # 21345 652.07 619.47 712.39 21195 1,347.09 1,279.74 1,471.70 21346 957.25 909.39 1,045.80 21196 1,459.92 1,386.92 1,594.96 21347 1,149.66 1,092.18 1,256.01 21198 1,146.60 1,089.27 1,252.66 21348 1,190.95 1,131.40 1,301.11 21199 1,005.65 955.37 1,098.68 21355 437.52 415.64 477.99 21206 1,114.92 1,059.17 1,218.05 # 21355 314.94 299.19 344.07 21208 1,685.80 1,601.51 1,841.74 21356 499.47 474.50 545.68 # 21208 825.03 783.78 901.35 # 21356 374.62 355.89 409.27 21209 816.41 775.59 891.93 21360 527.39 501.02 576.17 # 21209 645.25 612.99 704.94 21365 1,085.92 1,031.62 1,186.36 21210 1,993.41 1,893.74 2,177.80 21366 1,222.59 1,161.46 1,335.68 # 21210 827.10 785.75 903.61 21385 712.48 676.86 778.39 21215 3,373.95 3,205.25 3,686.04 21386 659.37 626.40 720.36 # 21215 861.08 818.03 940.73 21387 757.86 719.97 827.97 21230 770.83 732.29 842.13 21390 752.84 715.20 822.48 21235 728.66 692.23 796.06 21395 952.57 904.94 1,040.68 # 21235 561.59 533.51 613.54 21400 176.09 167.29 192.38 21240 1,113.41 1,057.74 1,216.40 # 21400 142.50 135.38 155.69 21242 1,025.60 974.32 1,120.47 21401 478.51 454.58 522.77 21243 1,664.43 1,581.21 1,818.39 # 21401 285.56 271.28 311.97 21244 1,043.90 991.71 1,140.47 21406 537.88 510.99 587.64 21245 1,138.76 1,081.82 1,244.09 21407 632.53 600.90 691.04 # 21245 908.58 863.15 992.62 21408 861.16 818.10 940.82 21246 864.92 821.67 944.92 21421 721.68 685.60 788.44 21247 1,616.33 1,535.51 1,765.84 # 21421 624.52 593.29 682.28 21248 1,051.19 998.63 1,148.42 21422 677.00 643.15 739.62 # 21248 873.22 829.56 953.99 21423 796.01 756.21 869.64 21249 1,468.15 1,394.74 1,603.95 21431 756.25 718.44 826.21 # 21249 1,237.52 1,175.64 1,351.99 21432 670.34 636.82 732.34 21255 1,398.01 1,328.11 1,527.33 21433 1,653.18 1,570.52 1,806.10 21256 1,143.75 1,086.56 1,249.54 21435 1,305.28 1,240.02 1,426.02 21260 1,235.78 1,173.99 1,350.09 21436 1,863.07 1,769.92 2,035.41 21261 2,178.63 2,069.70 2,380.16 21440 517.17 491.31 565.01 21263 1,912.01 1,816.41 2,088.87 # 21440 436.36 414.54 476.72 21267 1,584.36 1,505.14 1,730.91 21445 737.11 700.25 805.29 21268 1,813.60 1,722.92 1,981.36 # 21445 619.07 588.12 676.34 21270 909.04 863.59 993.13 21450 541.37 514.30 591.45 # 21270 689.76 655.27 753.56 # 21450 466.47 443.15 509.62 21275 797.35 757.48 871.10 21451 718.72 682.78 785.20 21280 518.26 492.35 566.20 # 21451 622.02 590.92 679.56 21282 348.28 330.87 380.50 21452 658.36 625.44 719.26 21295 176.80 167.96 193.15 # 21452 331.48 314.91 362.15 21296 408.95 388.50 446.78 21453 828.37 786.95 904.99 21310 119.03 113.08 130.04 # 21453 756.64 718.81 826.63 # 21310 27.78 26.39 30.35 21454 549.78 522.29 600.63 21315 270.28 256.77 295.29 21461 1,852.03 1,759.43 2,023.34 # 21315 149.97 142.47 163.84 # 21461 927.69 881.31 1,013.51 21320 257.59 244.71 281.42 21462 2,021.52 1,920.44 2,208.51 # 21320 138.64 131.71 151.47 # 21462 1,011.37 960.80 1,104.92 21325 506.34 481.02 553.17 21465 906.61 861.28 990.47 21330 610.44 579.92 666.91 21470 1,171.15 1,112.59 1,279.48 21335 746.66 709.33 815.73 21480 98.31 93.39 107.40 21336 662.37 629.25 723.64 # 21480 31.57 29.99 34.49 21337 401.83 381.74 439.00 21485 637.96 606.06 696.97 # 21337 285.16 270.90 311.54 # 21485 557.61 529.73 609.19 21338 807.00 766.65 881.65 21490 913.53 867.85 998.03 21339 863.74 820.55 943.63 21495 673.06 639.41 735.32 21340 789.32 749.85 862.33 21497 641.44 609.37 700.78 21343 1,183.55 1,124.37 1,293.03 # 21497 557.91 530.01 609.51 21344 1,498.20 1,423.29 1,636.78 21501 444.11 421.90 485.19 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 31146 PAGE 11 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 21501 316.08 300.28 345.32 # 22310 255.77 242.98 279.43 21502 523.02 496.87 571.40 22315 852.30 809.69 931.14 21510 476.16 452.35 520.20 # 22315 743.34 706.17 812.10 21550 258.10 245.20 281.98 22318 1,568.02 1,489.62 1,713.06 # 21550 157.31 149.44 171.86 22319 1,718.60 1,632.67 1,877.57 21555 428.53 407.10 468.17 22325 1,364.09 1,295.89 1,490.27 # 21555 322.29 306.18 352.11 22326 1,429.37 1,357.90 1,561.59 21556 405.27 385.01 442.76 22327 1,409.95 1,339.45 1,540.37 21557 571.34 542.77 624.19 22328 283.01 268.86 309.19 21600 547.82 520.43 598.49 22505 123.67 117.49 135.11 21610 1,056.10 1,003.30 1,153.80 22520 2,773.16 2,634.50 3,029.68 21615 677.33 643.46 739.98 # 22520 597.15 567.29 652.38 21616 829.81 788.32 906.57 22521 2,646.36 2,514.04 2,891.15 21620 526.49 500.17 575.20 # 22521 564.33 536.11 616.53 21627 553.64 525.96 604.85 22522 249.66 237.18 272.76 21630 1,253.57 1,190.89 1,369.52 22523 618.77 587.83 676.00 21632 1,235.66 1,173.88 1,349.96 22524 592.74 563.10 647.57 21685 980.35 931.33 1,071.03 22525 273.31 259.64 298.59 21700 428.95 407.50 468.63 22526 2,372.13 2,253.52 2,591.55 21705 616.43 585.61 673.45 # 22526 343.67 326.49 375.46 21720 379.38 360.41 414.47 22527 1,959.25 1,861.29 2,140.48 21725 528.56 502.13 577.45 # 22527 156.88 149.04 171.40 21740 1,067.96 1,014.56 1,166.74 22532 1,695.19 1,610.43 1,851.99 21750 709.85 674.36 775.51 22533 1,581.00 1,501.95 1,727.24 21800 98.37 93.45 107.47 22534 371.18 352.62 405.51 # 21800 99.73 94.74 108.95 22548 1,822.04 1,730.94 1,990.58 21805 257.63 244.75 281.46 22554 1,282.62 1,218.49 1,401.26 21810 507.36 481.99 554.29 22556 1,628.31 1,546.89 1,778.92 21820 133.99 127.29 146.38 22558 1,480.81 1,406.77 1,617.79 21825 571.46 542.89 624.32 22585 344.48 327.26 376.35 21920 252.44 239.82 275.79 22590 1,511.56 1,435.98 1,651.38 # 21920 153.47 145.80 167.67 22595 1,438.82 1,366.88 1,571.91 21925 417.30 396.44 455.91 22600 1,232.89 1,171.25 1,346.94 # 21925 328.32 311.90 358.69 22610 1,218.26 1,157.35 1,330.95 21930 465.68 442.40 508.76 22612 1,571.19 1,492.63 1,716.52 # 21930 361.71 343.62 395.16 22614 401.85 381.76 439.02 21935 1,134.59 1,077.86 1,239.54 22630 1,515.16 1,439.40 1,655.31 22010 887.98 843.58 970.12 22632 326.65 310.32 356.87 22015 881.99 837.89 963.57 22800 1,342.19 1,275.08 1,466.34 22100 805.35 765.08 879.84 22802 2,126.92 2,020.57 2,323.66 22101 803.67 763.49 878.01 22804 2,461.73 2,338.64 2,689.44 22102 806.31 765.99 880.89 22808 1,806.72 1,716.38 1,973.84 22103 143.94 136.74 157.25 22810 2,019.01 1,918.06 2,205.77 22110 989.03 939.58 1,080.52 22812 2,213.24 2,102.58 2,417.97 22112 983.90 934.71 1,074.92 22818 2,213.90 2,103.21 2,418.69 22114 986.64 937.31 1,077.91 22819 2,506.25 2,380.94 2,738.08 22116 144.23 137.02 157.57 22830 805.81 765.52 880.35 22206 2,303.36 2,188.19 2,516.42 22840 785.93 746.63 858.62 22207 2,275.16 2,161.40 2,485.61 22842 786.25 746.94 858.98 22208 575.42 546.65 628.65 22843 831.27 789.71 908.17 22210 1,739.09 1,652.14 1,899.96 22844 1,023.27 972.11 1,117.93 22212 1,437.99 1,366.09 1,571.00 22845 751.29 713.73 820.79 22214 1,453.58 1,380.90 1,588.04 22846 780.86 741.82 853.09 22216 377.27 358.41 412.17 22847 857.85 814.96 937.20 22220 1,573.60 1,494.92 1,719.16 22848 372.40 353.78 406.85 22222 1,424.66 1,353.43 1,556.44 22849 1,292.60 1,227.97 1,412.17 22224 1,552.40 1,474.78 1,696.00 22850 712.37 676.75 778.26 22226 375.45 356.68 410.18 22851 417.28 396.42 455.88 22305 186.74 177.40 204.01 22852 682.00 647.90 745.09 # 22305 169.94 161.44 185.66 22855 1,095.61 1,040.83 1,196.95 22310 277.10 263.25 302.74 22857 1,730.99 1,644.44 1,891.11 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 31146 PAGE 12 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 22862 2,040.66 1,938.63 2,229.42 23415 741.16 704.10 809.72 22865 1,987.87 1,888.48 2,171.75 23420 1,058.71 1,005.77 1,156.64 22900 393.16 373.50 429.53 23430 746.39 709.07 815.43 23000 548.73 521.29 599.48 23440 769.66 731.18 840.86 # 23000 361.23 343.17 394.65 23450 961.00 912.95 1,049.89 23020 692.53 657.90 756.59 23455 1,022.13 971.02 1,116.67 23030 449.58 427.10 491.17 23460 1,106.92 1,051.57 1,209.31 # 23030 259.35 246.38 283.34 23462 1,081.39 1,027.32 1,181.42 23031 438.03 416.13 478.55 23465 1,125.52 1,069.24 1,229.63 # 23031 223.74 212.55 244.43 23466 1,110.05 1,054.55 1,212.73 23035 698.51 663.58 763.12 23470 1,226.92 1,165.57 1,340.41 23040 721.17 685.11 787.88 23472 1,509.30 1,433.84 1,648.92 23044 573.91 545.21 626.99 23480 828.57 787.14 905.21 23065 209.82 199.33 229.23 23485 969.83 921.34 1,059.54 # 23065 162.60 154.47 177.64 23490 819.98 778.98 895.83 23066 518.48 492.56 566.44 23491 1,025.97 974.67 1,120.87 # 23066 340.51 323.48 372.00 23500 209.79 199.30 229.20 23075 262.40 249.28 286.67 # 23500 203.44 193.27 222.26 # 23075 174.78 166.04 190.95 23505 341.81 324.72 373.43 23076 555.66 527.88 607.06 # 23505 320.02 304.02 349.62 23077 1,159.20 1,101.24 1,266.43 23515 682.92 648.77 746.09 23100 489.00 464.55 534.23 23520 216.17 205.36 236.16 23101 452.78 430.14 494.66 # 23520 215.26 204.50 235.18 23105 639.01 607.06 698.12 23525 340.81 323.77 372.34 23106 481.33 457.26 525.85 # 23525 315.39 299.62 344.56 23107 665.20 631.94 726.73 23530 552.27 524.66 603.36 23120 564.40 536.18 616.61 23532 623.18 592.02 680.82 23125 702.89 667.75 767.91 23540 215.07 204.32 234.97 23130 609.66 579.18 666.06 # 23540 205.08 194.83 224.05 23140 510.64 485.11 557.88 23545 307.62 292.24 336.08 23145 689.79 655.30 753.60 # 23545 277.66 263.78 303.35 23146 618.73 587.79 675.96 23550 573.33 544.66 626.36 23150 649.85 617.36 709.96 23552 660.41 627.39 721.50 23155 787.99 748.59 860.88 23570 223.30 212.14 243.96 23156 674.31 640.59 736.68 # 23570 223.75 212.56 244.44 23170 535.11 508.35 584.60 23575 378.69 359.76 413.72 23172 552.74 525.10 603.87 # 23575 354.18 336.47 386.94 23174 753.23 715.57 822.91 23585 909.16 863.70 993.26 23180 707.66 672.28 773.12 23600 316.27 300.46 345.53 23182 681.27 647.21 744.29 # 23600 284.03 269.83 310.30 23184 763.30 725.14 833.91 23605 462.29 439.18 505.06 23190 556.33 528.51 607.79 # 23605 420.53 399.50 459.43 23195 747.14 709.78 816.25 23615 860.42 817.40 940.01 23200 866.80 823.46 946.98 23616 1,316.33 1,250.51 1,438.09 23210 908.68 863.25 992.74 23620 258.66 245.73 282.59 23220 1,072.59 1,018.96 1,171.80 # 23620 238.68 226.75 260.76 23221 1,251.33 1,188.76 1,367.07 23625 374.32 355.60 408.94 23222 1,680.64 1,596.61 1,836.10 # 23625 347.53 330.15 379.67 23330 233.19 221.53 254.76 23630 722.71 686.57 789.56 # 23330 150.56 143.03 164.48 23650 290.35 275.83 317.20 23331 591.13 561.57 645.81 # 23650 256.75 243.91 280.50 23332 887.07 842.72 969.13 23655 373.92 355.22 408.50 23350 177.62 168.74 194.05 23660 580.67 551.64 634.39 # 23350 52.32 49.70 57.16 23665 413.23 392.57 451.46 23395 1,282.88 1,218.74 1,401.55 # 23665 385.99 366.69 421.69 23397 1,146.69 1,089.36 1,252.76 23670 803.22 763.06 877.52 23400 978.32 929.40 1,068.81 23675 541.80 514.71 591.92 23405 633.76 602.07 692.38 # 23675 496.85 472.01 542.81 23406 789.39 749.92 862.41 23680 882.88 838.74 964.55 23410 903.32 858.15 986.87 23700 196.02 186.22 214.15 23412 959.93 911.93 1,048.72 23800 1,025.43 974.16 1,120.28 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 31146 PAGE 13 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 23802 1,210.05 1,149.55 1,321.98 24343 705.13 669.87 770.35 23900 1,326.43 1,260.11 1,449.13 24344 1,088.78 1,034.34 1,189.49 23920 1,076.71 1,022.87 1,176.30 24345 701.38 666.31 766.26 23921 447.38 425.01 488.76 24346 1,085.52 1,031.24 1,185.93 23930 374.26 355.55 408.88 24357 448.22 425.81 489.68 # 23930 215.36 204.59 235.28 24358 524.01 497.81 572.48 23931 305.68 290.40 333.96 24359 637.51 605.63 696.47 # 23931 161.31 153.24 176.23 24360 898.82 853.88 981.96 23935 503.84 478.65 550.45 24361 1,010.05 959.55 1,103.48 24000 471.76 448.17 515.40 24362 974.89 926.15 1,065.07 24006 711.55 675.97 777.37 24363 1,472.76 1,399.12 1,608.99 24065 246.06 233.76 268.82 24365 642.93 610.78 702.40 # 24065 162.07 153.97 177.07 24366 688.18 653.77 751.84 24066 601.00 570.95 656.59 24400 825.93 784.63 902.32 # 24066 393.07 373.42 429.43 24410 1,051.77 999.18 1,149.06 24075 487.01 462.66 532.06 24420 979.17 930.21 1,069.74 # 24075 308.13 292.72 336.63 24430 1,030.63 979.10 1,125.97 24076 467.83 444.44 511.11 24435 1,060.16 1,007.15 1,158.22 24077 805.91 765.61 880.45 24470 660.49 627.47 721.59 24100 397.93 378.03 434.73 24495 673.11 639.45 735.37 24101 499.50 474.53 545.71 24498 877.84 833.95 959.04 24102 616.63 585.80 673.67 24500 342.68 325.55 374.38 24105 339.43 322.46 370.83 # 24500 301.82 286.73 329.74 24110 582.62 553.49 636.51 24505 495.09 470.34 540.89 24115 666.99 633.64 728.69 # 24505 446.06 423.76 487.32 24116 871.44 827.87 952.05 24515 881.12 837.06 962.62 24120 522.78 496.64 571.14 24516 869.26 825.80 949.67 24125 591.11 561.55 645.78 24530 369.04 350.59 403.18 24126 631.46 599.89 689.87 # 24530 325.91 309.61 356.05 24130 508.28 482.87 555.30 24535 614.97 584.22 671.85 24134 764.63 726.40 835.36 # 24535 565.48 537.21 617.79 24136 630.31 598.79 688.61 24538 751.55 713.97 821.07 24138 659.63 626.65 720.65 24545 894.28 849.57 977.01 24140 735.11 698.35 803.10 24546 1,069.12 1,015.66 1,168.01 24145 621.27 590.21 678.74 24560 310.13 294.62 338.81 24147 649.32 616.85 709.38 # 24560 265.18 251.92 289.71 24149 1,142.31 1,085.19 1,247.97 24565 513.02 487.37 560.48 24150 975.40 926.63 1,065.62 # 24565 468.07 444.67 511.37 24151 1,129.37 1,072.90 1,233.84 24566 691.97 657.37 755.98 24152 722.26 686.15 789.07 24575 743.81 706.62 812.61 24153 671.10 637.55 733.18 24576 326.33 310.01 356.51 24155 841.03 798.98 918.83 # 24576 286.38 272.06 312.87 24160 607.43 577.06 663.62 24577 531.14 504.58 580.27 24164 497.84 472.95 543.89 # 24577 484.83 460.59 529.68 24200 208.71 198.27 228.01 24579 837.02 795.17 914.45 # 24200 136.53 129.70 149.16 24582 787.14 747.78 859.95 24201 584.83 555.59 638.93 24586 1,100.58 1,045.55 1,202.38 # 24201 364.19 345.98 397.88 24587 1,092.00 1,037.40 1,193.01 24220 191.26 181.70 208.96 24600 364.00 345.80 397.67 # 24220 68.68 65.25 75.04 # 24600 319.97 303.97 349.57 24300 403.34 383.17 440.65 24605 454.78 432.04 496.85 24301 754.05 716.35 823.80 24615 718.89 682.95 785.39 24305 581.25 552.19 635.02 24620 549.00 521.55 599.78 24310 476.64 452.81 520.73 24635 845.76 803.47 923.99 24320 763.31 725.14 833.91 24640 123.13 116.97 134.52 24330 720.49 684.47 787.14 # 24640 83.18 79.02 90.87 24331 792.32 752.70 865.61 24650 252.36 239.74 275.70 24332 600.29 570.28 655.82 # 24650 219.22 208.26 239.50 24340 616.79 585.95 673.84 24655 432.71 411.07 472.73 24341 718.34 682.42 784.78 # 24655 388.67 369.24 424.63 24342 790.44 750.92 863.56 24665 652.08 619.48 712.40 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 31146 PAGE 14 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 24666 734.88 698.14 802.86 25251 713.18 677.52 779.15 24670 282.36 268.24 308.48 25259 402.35 382.23 439.56 # 24670 245.59 233.31 268.31 25260 762.22 724.11 832.73 24675 452.51 429.88 494.36 25263 754.57 716.84 824.37 # 24675 410.74 390.20 448.73 25265 882.71 838.57 964.36 24685 655.79 623.00 716.45 25270 629.14 597.68 687.33 24800 802.41 762.29 876.63 25272 699.58 664.60 764.29 24802 992.30 942.69 1,084.09 25274 807.18 766.82 881.84 24900 707.24 671.88 772.66 25275 670.69 637.16 732.73 24920 697.75 662.86 762.29 25280 703.11 667.95 768.14 24925 539.40 512.43 589.29 25290 656.20 623.39 716.90 24930 735.10 698.35 803.10 25295 660.27 627.26 721.35 24931 773.27 734.61 844.80 25300 695.07 660.32 759.37 24935 1,059.90 1,006.91 1,157.95 25301 662.27 629.16 723.53 25000 384.90 365.66 420.51 25310 759.23 721.27 829.46 25001 332.39 315.77 363.14 25312 854.35 811.63 933.37 25020 614.40 583.68 671.23 25315 909.65 864.17 993.80 25023 1,142.39 1,085.27 1,248.06 25316 1,049.86 997.37 1,146.98 25024 746.34 709.02 815.37 25320 968.18 919.77 1,057.74 25025 1,127.94 1,071.54 1,232.27 25332 847.21 804.85 925.58 25028 538.00 511.10 587.77 25335 978.45 929.53 1,068.96 25031 426.04 404.74 465.45 25337 900.31 855.29 983.58 25035 740.69 703.66 809.21 25350 823.37 782.20 899.53 25040 585.34 556.07 639.48 25355 906.17 860.86 989.99 25065 246.76 234.42 269.58 25360 804.43 764.21 878.84 # 25065 163.23 155.07 178.33 25365 1,058.87 1,005.93 1,156.82 25066 414.57 393.84 452.92 25370 1,132.22 1,075.61 1,236.95 25075 359.11 341.15 392.32 25375 1,106.51 1,051.18 1,208.86 25076 508.29 482.88 555.31 25390 915.94 870.14 1,000.66 25077 807.80 767.41 882.52 25391 1,140.21 1,083.20 1,245.68 25085 488.58 464.15 533.77 25392 1,139.10 1,082.15 1,244.47 25100 362.81 344.67 396.37 25393 1,281.74 1,217.65 1,400.30 25101 422.66 401.53 461.76 25394 767.58 729.20 838.58 25105 515.45 489.68 563.13 25400 960.29 912.28 1,049.12 25107 625.49 594.22 683.35 25405 1,191.48 1,131.91 1,301.70 25109 507.63 482.25 554.59 25415 1,124.05 1,067.85 1,228.03 25110 401.38 381.31 438.51 25420 1,317.08 1,251.23 1,438.91 25111 326.58 310.25 356.79 25425 1,221.80 1,160.71 1,334.82 25112 395.02 375.27 431.56 25426 1,238.69 1,176.76 1,353.27 25115 874.12 830.41 954.97 25430 702.79 667.65 767.80 25116 733.55 696.87 801.40 25431 792.04 752.44 865.31 25118 401.52 381.44 438.66 25440 792.81 753.17 866.15 25119 532.14 505.53 581.36 25441 939.45 892.48 1,026.35 25120 638.51 606.58 697.57 25442 806.44 766.12 881.04 25125 719.68 683.70 786.26 25443 775.79 737.00 847.55 25126 736.75 699.91 804.90 25444 824.86 783.62 901.16 25130 465.42 442.15 508.47 25445 725.69 689.41 792.82 25135 575.16 546.40 628.36 25446 1,178.94 1,119.99 1,287.99 25136 510.29 484.78 557.50 25447 811.08 770.53 886.11 25145 650.17 617.66 710.31 25449 1,036.09 984.29 1,131.93 25150 603.46 573.29 659.28 25450 640.97 608.92 700.26 25151 720.82 684.78 787.50 25455 768.33 729.91 839.40 25170 966.34 918.02 1,055.72 25490 844.13 801.92 922.21 25210 507.70 482.32 554.67 25491 885.77 841.48 967.70 25215 655.35 622.58 715.97 25492 1,045.27 993.01 1,141.96 25230 452.10 429.50 493.93 25500 255.41 242.64 279.04 25240 468.49 445.07 511.83 # 25500 225.90 214.61 246.80 25246 194.02 184.32 211.97 25505 496.04 471.24 541.93 # 25246 76.44 72.62 83.51 # 25505 451.09 428.54 492.82 25248 491.04 466.49 536.46 25515 670.91 637.36 732.96 25250 524.17 497.96 572.65 25520 542.57 515.44 592.76 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 31146 PAGE 15 FSY08 LOCALITY FEE SCHEDULE FOR AREA 18 DATE 12/26/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 25520 511.70 486.12 559.04 25929 568.99 540.54 621.62 25525 828.08 786.68 904.68 25931 764.35 726.13 835.05 25526 1,029.31 977.84 1,124.52 26010 278.66 264.73 304.44 25530 250.56 238.03 273.73 # 26010 131.57 124.99 143.74 # 25530 218.78 207.84 239.02 26011 430.58 409.05 470.41 25535 474.77 451.03 518.68 # 26011 185.42 176.15 202.57 # 25535 442.08 419.98 482.98 26020 427.15 405.79