1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 1 FSY08 LOCALITY FEE SCHEDULE FOR AREA 26 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 40.30 38.29 44.03 # G0268 32.44 30.82 35.44 G0102 23.43 22.26 25.60 G0270 27.18 25.82 29.69 # G0102 9.11 8.65 9.95 # G0270 26.70 25.37 29.18 G0104 150.76 143.22 164.70 G0271 15.21 14.45 16.62 # G0104 62.88 59.74 68.70 # G0271 14.73 13.99 16.09 G0105 437.44 415.57 477.91 G0275 14.73 13.99 16.09 # G0105 216.78 205.94 236.83 G0278 14.73 13.99 16.09 G0105 53 150.76 143.22 164.70 G0281 12.37 11.75 13.51 # G0105 53 62.88 59.74 68.70 G0283 12.37 11.75 13.51 G0106 219.03 208.08 239.29 G0288 284.44 270.22 310.75 G0106 TC 167.67 159.29 183.18 G0289 92.81 88.17 101.40 G0106 26 51.35 48.78 56.10 G0308 793.04 753.39 866.40 G0108 34.24 32.53 37.41 G0309 648.71 616.27 708.71 G0109 19.44 18.47 21.24 G0310 506.40 481.08 553.24 G0117 51.43 48.86 56.19 G0311 546.07 518.77 596.59 G0118 35.85 34.06 39.17 G0312 448.93 426.48 490.45 C G0120 214.73 203.99 234.59 G0313 351.51 333.93 384.02 C G0120 TC 163.37 155.20 178.48 G0314 482.35 458.23 526.96 G0120 26 51.35 48.78 56.10 G0315 396.11 376.30 432.75 G0121 437.44 415.57 477.91 G0316 306.91 291.56 335.29 # G0121 216.78 205.94 236.83 G0317 304.36 289.14 332.51 G0121 53 150.76 143.22 164.70 G0318 248.99 236.54 272.02 # G0121 53 62.88 59.74 68.70 G0319 194.01 184.31 211.96 G0124 27.65 26.27 30.21 G0320 613.84 583.15 670.62 G0127 21.52 20.44 23.51 G0321 431.74 410.15 471.67 # G0127 9.11 8.65 9.95 G0322 375.58 356.80 410.32 G0128 4.04 3.84 4.42 G0323 235.61 223.83 257.40 G0130 43.87 41.68 47.93 G0324 22.09 20.99 24.14 G0130 TC 32.71 31.07 35.73 G0325 12.99 12.34 14.19 G0130 26 11.16 10.60 12.19 G0326 15.04 14.29 16.43 G0141 27.65 26.27 30.21 G0327 8.40 7.98 9.18 G0166 195.65 185.87 213.75 G0329 9.47 9.00 10.35 G0168 100.81 95.77 110.14 G0332 94.09 89.39 102.80 # G0168 26.78 25.44 29.26 G0339 3,915.07 3,719.32 4,277.22 G0179 52.24 49.63 57.07 G0340 2,658.17 2,525.26 2,904.05 G0180 67.70 64.32 73.97 G0341 376.62 357.79 411.46 G0181 116.64 110.81 127.43 G0342 709.51 674.03 775.13 G0182 121.41 115.34 132.64 G0343 1,170.91 1,112.36 1,279.21 G0186 368.26 349.85 402.33 G0344 103.29 98.13 112.85 G0202 161.00 152.95 175.89 # G0344 71.29 67.73 77.89 G0202 TC 124.60 118.37 136.13 G0364 14.01 13.31 15.31 G0202 26 36.40 34.58 39.77 # G0364 9.71 9.22 10.60 G0204 181.57 172.49 198.36 C G0365 200.49 190.47 219.04 G0204 TC 136.06 129.26 148.65 C G0365 TC 187.34 177.97 204.67 G0204 26 45.51 43.23 49.71 G0365 26 13.15 12.49 14.36 G0206 144.91 137.66 158.31 G0366 26.97 25.62 29.46 G0206 TC 108.50 103.08 118.54 G0367 17.86 16.97 19.52 G0206 26 36.40 34.58 39.77 G0368 9.11 8.65 9.95 G0237 16.90 16.06 18.47 G0372 16.75 15.91 18.30 G0238 17.86 16.97 19.52 # G0372 8.63 8.20 9.43 G0239 15.95 15.15 17.42 G0389 138.85 131.91 151.70 G0245 70.34 66.82 76.84 G0389 TC 108.22 102.81 118.23 # G0245 45.98 43.68 50.23 G0389 26 30.64 29.11 33.48 G0246 42.69 40.56 46.64 G0392 2,852.64 2,710.01 3,116.51 # G0246 23.58 22.40 25.76 # G0392 515.21 489.45 562.87 G0247 46.65 44.32 50.97 G0393 2,176.73 2,067.89 2,378.07 # G0247 26.59 25.26 29.05 # G0393 329.81 313.32 360.32 G0248 239.62 227.64 261.79 G0396 31.86 30.27 34.81 G0249 176.09 167.29 192.38 # G0396 29.94 28.44 32.71 G0250 9.98 9.48 10.90 G0397 62.13 59.02 67.87 G0268 52.98 50.33 57.88 # G0397 59.74 56.75 65.26 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 26 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 25.24 23.98 27.58 10022 159.01 151.06 173.72 G9042 11.52 10.94 12.58 # 10022 66.35 63.03 72.48 G9043 11.52 10.94 12.58 10040 98.90 93.96 108.05 G9044 10.09 9.59 11.03 # 10040 85.05 80.80 92.92 M0064 42.94 40.79 46.91 10060 110.30 104.79 120.51 # M0064 17.63 16.75 19.26 # 10060 93.58 88.90 102.24 P3001 27.65 26.27 30.21 10061 185.67 176.39 202.85 Q0035 24.58 23.35 26.85 # 10061 164.18 155.97 179.37 Q0035 TC 15.95 15.15 17.42 10080 183.04 173.89 199.97 Q0035 26 8.63 8.20 9.43 # 10080 98.03 93.13 107.10 Q0091 47.57 45.19 51.97 10081 274.38 260.66 299.76 # Q0091 19.39 18.42 21.18 # 10081 164.05 155.85 179.23 Q0092 19.44 18.47 21.24 10120 144.91 137.66 158.31 R0070 191.66 182.08 209.39 # 10120 92.38 87.76 100.92 R0075 191.66 182.08 209.39 10121 272.75 259.11 297.98 0016T 368.26 349.85 402.33 # 10121 187.26 177.90 204.59 0030T 26.73 25.39 29.20 10140 156.36 148.54 170.82 0067T 509.17 483.71 556.27 # 10140 121.50 115.43 132.74 C 0067T TC 234.45 222.73 256.14 10160 128.95 122.50 140.88 0067T 26 67.75 64.36 74.01 # 10160 98.38 93.46 107.48 0073T 749.40 711.93 818.72 10180 239.43 227.46 261.58 0075T 1,196.78 1,136.94 1,307.48 # 10180 180.68 171.65 197.40 0075T 26 904.50 859.28 988.17 11000 54.25 51.54 59.27 0076T 394.93 375.18 431.46 # 11000 32.28 30.67 35.27 0076T 26 90.45 85.93 98.82 11001 22.56 21.43 24.64 0078T 1,489.83 1,415.34 1,627.64 # 11001 16.35 15.53 17.86 0079T 143.89 136.70 157.21 11004 566.38 538.06 618.77 0080T 261.82 248.73 286.04 11005 748.85 711.41 818.12 0081T 26.18 24.87 28.60 11006 707.23 671.87 772.65 0144T 321.60 305.52 351.35 11008 272.87 259.23 298.11 C 0144T TC 123.53 117.35 134.95 11010 493.98 469.28 539.67 0144T 26 60.30 57.29 65.88 # 11010 285.74 271.45 312.17 0145T 477.38 453.51 521.54 11011 558.93 530.98 610.63 C 0145T TC 366.28 347.97 400.17 # 11011 300.06 285.06 327.82 0145T 26 75.38 71.61 82.35 11012 781.23 742.17 853.50 0146T 633.15 601.49 691.71 # 11012 442.61 420.48 483.55 C 0146T TC 366.28 347.97 400.17 11040 47.98 45.58 52.42 0146T 26 100.50 95.48 109.80 # 11040 27.92 26.52 30.50 0147T 633.15 601.49 691.71 11041 57.16 54.30 62.45 C 0147T TC 366.28 347.97 400.17 # 11041 36.62 34.79 40.01 0147T 26 100.50 95.48 109.80 11042 77.75 73.86 84.94 0148T 633.15 601.49 691.71 # 11042 48.13 45.72 52.58 C 0148T TC 366.28 347.97 400.17 11043 280.49 266.47 306.44 0148T 26 100.50 95.48 109.80 # 11043 240.37 228.35 262.60 0149T 633.15 601.49 691.71 11044 378.97 360.02 414.02 C 0149T TC 366.28 347.97 400.17 # 11044 332.16 315.55 362.88 0149T 26 100.50 95.48 109.80 11055 49.11 46.65 53.65 0150T 633.15 601.49 691.71 # 11055 23.32 22.15 25.47 C 0150T TC 366.28 347.97 400.17 11056 59.89 56.90 65.44 0150T 26 100.50 95.48 109.80 # 11056 32.67 31.04 35.70 0151T 201.00 190.95 219.59 11057 71.97 68.37 78.63 C 0151T TC 123.53 117.35 134.95 # 11057 42.84 40.70 46.81 0151T 26 60.30 57.29 65.88 11100 103.47 98.30 113.05 0159T 20.60 19.57 22.51 # 11100 47.11 44.75 51.46 0159T TC 17.34 16.47 18.94 11101 32.51 30.88 35.51 0159T 26 3.27 3.11 3.58 # 11101 23.92 22.72 26.13 0171T 830.84 789.30 907.70 11200 82.87 78.73 90.54 0172T 415.43 394.66 453.86 # 11200 68.54 65.11 74.88 0177T 1,390.30 1,320.79 1,518.91 11201 18.55 17.62 20.26 10021 151.08 143.53 165.06 # 11201 16.64 15.81 18.18 # 10021 69.41 65.94 75.83 11300 70.78 67.24 77.33 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 26 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 28.75 27.31 31.41 11451 478.45 454.53 522.71 11301 93.44 88.77 102.09 # 11451 298.86 283.92 326.51 # 11301 49.02 46.57 53.56 11462 361.18 343.12 394.59 11302 110.97 105.42 121.23 # 11462 218.85 207.91 239.10 # 11302 60.34 57.32 65.92 11463 487.85 463.46 532.98 11303 131.70 125.12 143.89 # 11463 303.02 287.87 331.05 # 11303 71.05 67.50 77.63 11470 391.83 372.24 428.08 11305 71.42 67.85 78.03 # 11470 257.14 244.28 280.92 # 11305 37.03 35.18 40.46 11471 501.99 476.89 548.42 11306 96.77 91.93 105.72 # 11471 324.32 308.10 354.32 # 11306 55.70 52.92 60.86 11600 186.55 177.22 203.80 11307 112.88 107.24 123.33 # 11600 108.22 102.81 118.23 # 11307 64.64 61.41 70.62 11601 220.72 209.68 241.13 11308 128.62 122.19 140.52 # 11601 139.05 132.10 151.92 # 11308 78.95 75.00 86.25 11602 240.31 228.29 262.53 11310 86.24 81.93 94.22 # 11602 151.00 143.45 164.97 # 11310 41.82 39.73 45.69 11603 271.45 257.88 296.56 11311 106.19 100.88 116.01 # 11603 177.84 168.95 194.29 # 11311 60.82 57.78 66.45 11604 299.32 284.35 327.00 11312 123.50 117.33 134.93 # 11604 194.24 184.53 212.21 # 11312 70.01 66.51 76.49 11606 412.77 392.13 450.95 11313 155.17 147.41 169.52 # 11606 284.77 270.53 311.11 # 11313 94.03 89.33 102.73 11620 188.04 178.64 205.44 11400 124.98 118.73 136.54 # 11620 109.24 103.78 119.35 # 11400 75.78 71.99 82.79 11621 222.55 211.42 243.13 11401 147.90 140.51 161.59 # 11621 140.88 133.84 153.92 # 11401 98.71 93.77 107.84 11622 250.40 237.88 273.56 11402 163.88 155.69 179.04 # 11622 161.56 153.48 176.50 # 11402 108.00 102.60 117.99 11623 290.74 276.20 317.63 11403 186.72 177.38 203.99 # 11623 197.13 187.27 215.36 # 11403 137.05 130.20 149.73 11624 327.99 311.59 358.33 11404 211.84 201.25 231.44 # 11624 224.83 213.59 245.63 # 11404 151.18 143.62 165.16 11626 402.55 382.42 439.78 11406 288.77 274.33 315.48 # 11626 286.01 271.71 312.47 # 11406 220.47 209.45 240.87 11640 196.57 186.74 214.75 11420 123.62 117.44 135.06 # 11640 117.29 111.43 128.14 # 11420 82.07 77.97 89.67 11641 238.01 226.11 260.03 11421 156.55 148.72 171.03 # 11641 153.96 146.26 168.20 # 11421 108.79 103.35 118.85 11642 273.00 259.35 298.25 11422 174.67 165.94 190.83 # 11642 180.34 171.32 197.02 # 11422 130.73 124.19 142.82 11643 318.57 302.64 348.04 11423 202.76 192.62 221.51 # 11643 223.05 211.90 243.69 # 11423 151.18 143.62 165.16 11644 394.25 374.54 430.72 11424 231.42 219.85 252.83 # 11644 278.67 264.74 304.45 # 11424 174.10 165.40 190.21 11646 514.17 488.46 561.73 11426 323.92 307.72 353.88 # 11646 393.34 373.67 429.72 # 11426 260.40 247.38 284.49 11719 21.38 20.31 23.36 11440 138.41 131.49 151.21 # 11719 9.44 8.97 10.32 # 11440 100.67 95.64 109.99 11720 31.46 29.89 34.37 11441 169.03 160.58 184.67 # 11720 17.13 16.27 18.71 # 11441 128.91 122.46 140.83 11721 44.64 42.41 48.77 11442 189.28 179.82 206.79 # 11721 29.35 27.88 32.06 # 11442 142.48 135.36 155.66 11730 99.22 94.26 108.40 11443 225.78 214.49 246.66 # 11730 60.05 57.05 65.61 # 11443 174.67 165.94 190.83 11732 45.42 43.15 49.62 11444 281.86 267.77 307.94 # 11732 30.62 29.09 33.45 # 11444 221.68 210.60 242.19 11740 46.33 44.01 50.61 11446 373.32 354.65 407.85 # 11740 32.95 31.30 36.00 # 11446 309.32 293.85 337.93 11750 212.69 202.06 232.37 11450 363.03 344.88 396.61 # 11750 177.34 168.47 193.74 # 11450 226.44 215.12 247.39 11752 300.76 285.72 328.58 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 26 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 269.71 256.22 294.65 12013 179.34 170.37 195.93 11755 135.92 129.12 148.49 # 12013 119.16 113.20 130.18 # 11755 86.25 81.94 94.23 12014 209.57 199.09 228.95 11760 206.28 195.97 225.37 # 12014 142.23 135.12 155.39 # 11760 139.41 132.44 152.31 12015 262.48 249.36 286.76 11762 269.94 256.44 294.91 # 12015 177.46 168.59 193.88 # 11762 208.80 198.36 228.11 12016 309.45 293.98 338.08 11765 133.98 127.28 146.37 # 12016 215.84 205.05 235.81 # 11765 69.50 66.03 75.93 12017 261.15 248.09 285.30 11770 268.08 254.68 292.88 12018 313.31 297.64 342.29 # 11770 174.47 165.75 190.61 12020 280.93 266.88 306.91 11771 525.43 499.16 574.03 # 12020 189.23 179.77 206.74 # 11771 399.34 379.37 436.28 12021 160.46 152.44 175.31 11772 651.59 619.01 711.86 # 12021 138.01 131.11 150.78 # 11772 534.10 507.40 583.51 12031 228.46 217.04 249.60 11900 56.04 53.24 61.23 # 12031 146.31 138.99 159.84 # 11900 29.77 28.28 32.52 12032 307.93 292.53 336.41 11901 68.21 64.80 74.52 # 12032 189.01 179.56 206.49 # 11901 46.24 43.93 50.52 12034 296.59 281.76 324.02 11920 208.15 197.74 227.40 # 12034 192.47 182.85 210.28 # 11920 115.97 110.17 126.70 12035 383.06 363.91 418.50 11921 234.69 222.96 256.40 # 12035 234.04 222.34 255.69 # 11921 136.78 129.94 149.43 12036 421.03 399.98 459.98 11922 68.46 65.04 74.80 # 12036 273.44 259.77 298.74 # 11922 30.73 29.19 33.57 12037 472.70 449.07 516.43 11950 79.38 75.41 86.72 # 12037 317.95 302.05 347.36 # 11950 48.81 46.37 53.33 12041 242.34 230.22 264.75 11951 102.33 97.21 111.79 # 12041 158.28 150.37 172.93 # 11951 65.55 62.27 71.61 12042 286.67 272.34 313.19 11952 147.11 139.75 160.71 # 12042 186.85 177.51 204.14 # 11952 98.39 93.47 107.49 12044 324.32 308.10 354.32 11954 173.77 165.08 189.84 # 12044 203.01 192.86 221.79 # 11954 112.16 106.55 122.53 12045 386.03 366.73 421.74 11960 926.63 880.30 1,012.35 # 12045 243.71 231.52 266.25 11970 601.21 571.15 656.82 12046 456.05 433.25 498.24 11971 516.61 490.78 564.40 # 12046 286.02 271.72 312.48 # 11971 308.85 293.41 337.42 12047 487.40 463.03 532.48 11976 150.97 143.42 164.93 # 12047 317.85 301.96 347.25 # 11976 96.52 91.69 105.44 12051 269.14 255.68 294.03 11980 107.11 101.75 117.01 # 12051 173.62 164.94 189.68 # 11980 79.88 75.89 87.27 12052 295.89 281.10 323.27 11981 141.16 134.10 154.22 # 12052 198.45 188.53 216.81 # 11981 85.28 81.02 93.17 12053 323.07 306.92 352.96 11982 162.06 153.96 177.05 # 12053 204.15 193.94 223.03 # 11982 103.79 98.60 113.39 12054 345.42 328.15 377.37 11983 239.75 227.76 261.92 # 12054 218.38 207.46 238.58 # 11983 188.65 179.22 206.10 12055 419.71 398.72 458.53 12001 153.30 145.64 167.49 # 12055 269.74 256.25 294.69 # 12001 100.28 95.27 109.56 12056 519.67 493.69 567.74 12002 162.73 154.59 177.78 # 12056 336.27 319.46 367.38 # 12002 112.59 106.96 123.00 12057 557.73 529.84 609.32 12004 190.44 180.92 208.06 # 12057 385.31 366.04 420.95 # 12004 131.69 125.11 143.88 13100 320.25 304.24 349.88 12005 236.54 224.71 258.42 # 13100 231.89 220.30 253.35 # 12005 162.99 154.84 178.07 13101 398.05 378.15 434.87 12006 293.52 278.84 320.67 # 13101 280.08 266.08 305.99 # 12006 206.11 195.80 225.17 13102 107.43 102.06 117.37 12007 329.79 313.30 360.30 # 13102 73.52 69.84 80.32 # 12007 236.66 224.83 258.55 13120 331.89 315.30 362.60 12011 163.63 155.45 178.77 # 13120 241.14 229.08 263.44 # 12011 103.93 98.73 113.54 13121 435.61 413.83 475.90 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 5 FSY08 LOCALITY FEE SCHEDULE FOR AREA 26 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 313.34 297.67 342.32 15120 945.93 898.63 1,033.42 13122 123.78 117.59 135.23 # 15120 782.59 743.46 854.98 # 13122 83.66 79.48 91.40 15121 294.14 279.43 321.34 13131 364.58 346.35 398.30 # 15121 179.52 170.54 196.12 # 13131 273.36 259.69 298.64 15130 715.00 679.25 781.14 13132 565.07 536.82 617.34 # 15130 574.11 545.40 627.21 # 13132 453.31 430.64 495.24 15131 100.05 95.05 109.31 13133 166.54 158.21 181.94 # 15131 85.72 81.43 93.64 # 13133 129.76 123.27 141.76 15135 881.73 837.64 963.29 13150 372.89 354.25 407.39 # 15135 781.91 742.81 854.23 # 13150 274.51 260.78 299.90 15136 95.42 90.65 104.25 13151 411.54 390.96 449.60 # 15136 86.82 82.48 94.85 # 13151 316.97 301.12 346.29 15150 730.64 694.11 798.23 13152 557.36 529.49 608.91 # 15150 651.83 619.24 712.13 # 13152 423.16 402.00 462.30 15151 130.69 124.16 142.78 13153 185.74 176.45 202.92 # 15151 114.93 109.18 125.56 # 13153 142.27 135.16 155.43 15152 160.38 152.36 175.21 13160 800.64 760.61 874.70 # 15152 143.66 136.48 156.95 14000 657.52 624.64 718.34 15155 753.15 715.49 822.81 # 14000 531.43 504.86 580.59 # 15155 700.62 665.59 765.43 14001 848.19 805.78 926.65 15156 171.77 163.18 187.66 # 14001 707.77 672.38 773.24 # 15156 159.35 151.38 174.09 14020 732.27 695.66 800.01 15157 191.46 181.89 209.17 # 14020 607.61 577.23 663.81 # 15157 173.79 165.10 189.87 14021 951.23 903.67 1,039.22 15170 413.07 392.42 451.28 # 14021 819.41 778.44 895.21 # 15170 344.30 327.09 376.15 14040 766.98 728.63 837.92 15171 90.45 85.93 98.82 # 14040 652.35 619.73 712.69 # 15171 85.68 81.40 93.61 14041 1,041.23 989.17 1,137.55 15175 540.96 513.91 591.00 # 14041 894.13 849.42 976.83 # 15175 475.05 451.30 519.00 14060 778.61 739.68 850.63 15176 145.82 138.53 159.31 # 14060 686.43 652.11 749.93 # 15176 137.23 130.37 149.93 14061 1,130.86 1,074.32 1,235.47 15200 805.11 764.85 879.58 # 14061 969.43 920.96 1,059.10 # 15200 643.68 611.50 703.23 14300 1,087.49 1,033.12 1,188.09 15201 161.38 153.31 176.31 # 14300 943.25 896.09 1,030.50 # 15201 77.80 73.91 85.00 14350 755.20 717.44 825.06 15220 773.13 734.47 844.64 15002 344.28 327.07 376.13 # 15220 623.16 592.00 680.80 # 15002 223.44 212.27 244.11 15221 149.84 142.35 163.70 15003 74.21 70.50 81.08 # 15221 71.99 68.39 78.65 # 15003 43.65 41.47 47.69 15240 913.80 868.11 998.33 15004 412.42 391.80 450.57 # 15240 785.33 746.06 857.97 # 15004 275.83 262.04 301.35 15241 191.17 181.61 208.85 15005 122.08 115.98 133.38 # 15241 113.32 107.65 123.80 # 15005 88.17 83.76 96.32 15260 972.95 924.30 1,062.95 15040 280.29 266.28 306.22 # 15260 845.91 803.61 924.15 # 15040 129.36 122.89 141.32 15261 219.82 208.83 240.15 15050 552.47 524.85 603.58 # 15261 145.31 138.04 158.75 # 15050 446.92 424.57 488.26 15300 335.95 319.15 367.02 15100 914.47 868.75 999.06 # 15300 281.98 267.88 308.06 # 15100 726.77 690.43 793.99 15301 61.29 58.23 66.96 15101 215.52 204.74 235.45 # 15301 56.51 53.68 61.73 # 15101 115.69 109.91 126.40 15320 381.91 362.81 417.23 15110 884.65 840.42 966.48 # 15320 322.20 306.09 352.00 # 15110 739.93 702.93 808.37 15321 91.93 87.33 100.43 15111 124.43 118.21 135.94 # 15321 85.24 80.98 93.13 # 15111 106.28 100.97 116.12 15330 314.06 298.36 343.11 15115 867.03 823.68 947.23 # 15330 258.66 245.73 282.59 # 15115 762.91 724.76 833.47 15331 61.76 58.67 67.47 15116 164.01 155.81 179.18 # 15331 57.47 54.60 62.79 # 15116 144.91 137.66 158.31 15335 336.65 319.82 367.79 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 26 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 280.77 266.73 306.74 15770 655.89 623.10 716.57 15336 90.19 85.68 98.53 15775 324.39 308.17 354.40 # 15336 82.07 77.97 89.67 # 15775 214.54 203.81 234.38 15340 327.40 311.03 357.68 15776 459.82 436.83 502.35 # 15340 272.96 259.31 298.21 # 15776 333.73 317.04 364.60 15341 48.94 46.49 53.46 15780 860.80 817.76 940.42 # 15341 27.44 26.07 29.98 # 15780 670.23 636.72 732.23 15360 373.14 354.48 407.65 15781 553.98 526.28 605.22 # 15360 308.66 293.23 337.21 # 15781 444.61 422.38 485.74 15361 70.23 66.72 76.73 15782 606.25 575.94 662.33 # 15361 63.06 59.91 68.90 # 15782 437.65 415.77 478.14 15365 370.61 352.08 404.89 15783 512.80 487.16 560.23 # 15365 311.87 296.28 340.72 # 15783 378.11 359.20 413.08 15366 88.55 84.12 96.74 15786 248.32 235.90 271.29 # 15366 81.38 77.31 88.91 # 15786 136.08 129.28 148.67 15400 382.58 363.45 417.97 15787 58.60 55.67 64.02 # 15400 353.45 335.78 386.15 # 15787 18.48 17.56 20.19 15401 108.57 103.14 118.61 15788 462.51 439.38 505.29 # 15401 57.94 55.04 63.30 # 15788 248.06 235.66 271.01 15420 431.11 409.55 470.98 15789 595.17 565.41 650.22 # 15420 377.14 358.28 412.02 # 15789 430.88 409.34 470.74 15421 118.20 112.29 129.13 15792 452.91 430.26 494.80 # 15421 85.24 80.98 93.13 # 15792 284.79 270.55 311.13 15430 550.41 522.89 601.32 15793 482.53 458.40 527.16 # 15430 530.35 503.83 579.40 # 15793 360.26 342.25 393.59 15570 902.60 857.47 986.09 15819 725.59 689.31 792.71 # 15570 702.96 667.81 767.98 15820 543.45 516.28 593.72 15572 844.95 802.70 923.11 # 15820 481.36 457.29 525.88 # 15572 697.85 662.96 762.40 15821 578.18 549.27 631.66 15574 911.85 866.26 996.20 # 15821 508.44 483.02 555.47 # 15574 759.01 721.06 829.22 15822 432.78 411.14 472.81 15576 813.77 773.08 889.04 # 15822 373.56 354.88 408.11 # 15576 669.53 636.05 731.46 15823 662.16 629.05 723.41 15600 385.26 366.00 420.90 # 15823 597.69 567.81 652.98 # 15600 215.71 204.92 235.66 15830 1,152.55 1,094.92 1,259.16 15610 342.12 325.01 373.76 15832 890.87 846.33 973.28 # 15610 251.86 239.27 275.16 15833 830.64 789.11 907.48 15620 477.82 453.93 522.02 15834 847.43 805.06 925.82 # 15620 323.07 306.92 352.96 15835 864.46 821.24 944.43 15630 485.56 461.28 530.47 15836 730.99 694.44 798.61 # 15630 350.40 332.88 382.81 15837 775.88 737.09 847.65 15650 519.41 493.44 567.46 # 15837 678.45 644.53 741.21 # 15650 380.43 361.41 415.62 15838 574.42 545.70 627.56 15731 1,100.48 1,045.46 1,202.28 15839 842.77 800.63 920.72 # 15731 978.22 929.31 1,068.71 # 15839 705.70 670.42 770.98 15732 1,531.22 1,454.66 1,672.86 15840 1,007.25 956.89 1,100.42 # 15732 1,306.75 1,241.41 1,427.62 15841 1,657.26 1,574.40 1,810.56 15734 1,575.38 1,496.61 1,721.10 15842 2,621.55 2,490.47 2,864.04 # 15734 1,346.60 1,279.27 1,471.16 15845 935.93 889.13 1,022.50 15736 1,424.26 1,353.05 1,556.01 15851 104.05 98.85 113.68 # 15736 1,165.87 1,107.58 1,273.72 # 15851 44.82 42.58 48.97 15738 1,503.10 1,427.95 1,642.14 15852 46.78 44.44 51.11 # 15738 1,268.11 1,204.70 1,385.41 15860 110.64 105.11 120.88 15740 988.72 939.28 1,080.17 15920 577.68 548.80 631.12 # 15740 844.48 802.26 922.60 15922 745.50 708.23 814.46 15750 916.20 870.39 1,000.95 15931 655.88 623.09 716.55 15756 2,362.48 2,244.36 2,581.01 15933 814.72 773.98 890.08 15757 2,354.12 2,236.41 2,571.87 15934 905.38 860.11 989.13 15758 2,349.13 2,231.67 2,566.42 15935 1,075.90 1,022.11 1,175.43 15760 852.43 809.81 931.28 15936 884.52 840.29 966.33 # 15760 705.80 670.51 771.09 15937 1,037.14 985.28 1,133.07 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 7 FSY08 LOCALITY FEE SCHEDULE FOR AREA 26 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 680.20 646.19 743.12 17276 280.51 266.48 306.45 15941 906.78 861.44 990.66 # 17276 204.10 193.90 222.99 15944 880.01 836.01 961.41 17280 138.06 131.16 150.83 15945 973.03 924.38 1,063.04 # 17280 86.96 82.61 95.00 15946 1,601.53 1,521.45 1,749.67 17281 173.39 164.72 189.43 15950 567.50 539.13 620.00 # 17281 120.38 114.36 131.51 15951 808.37 767.95 883.14 17282 200.51 190.48 219.05 15952 837.72 795.83 915.20 # 17282 138.90 131.96 151.75 15953 935.93 889.13 1,022.50 17283 241.49 229.42 263.83 15956 1,134.52 1,077.79 1,239.46 # 17283 173.67 164.99 189.74 15958 1,161.98 1,103.88 1,269.46 17284 280.95 266.90 306.94 16000 71.11 67.55 77.68 # 17284 206.44 196.12 225.54 # 16000 45.32 43.05 49.51 17286 355.94 338.14 388.86 16020 87.54 83.16 95.63 # 17286 280.00 266.00 305.90 # 16020 57.45 54.58 62.77 17311 734.54 697.81 802.48 16025 150.28 142.77 164.19 # 17311 368.69 350.26 402.80 # 16025 113.98 108.28 124.52 17312 448.00 425.60 489.44 16030 181.79 172.70 198.61 # 17312 196.30 186.49 214.46 # 16030 131.16 124.60 143.29 17313 672.17 638.56 734.34 16035 211.74 201.15 231.32 # 17313 331.16 314.60 361.79 16036 83.96 79.76 91.72 17314 414.17 393.46 452.48 17000 79.49 75.52 86.85 # 17314 181.57 172.49 198.36 # 17000 53.23 50.57 58.16 17315 85.77 81.48 93.70 17003 7.95 7.55 8.68 # 17315 51.86 49.27 56.66 # 17003 5.08 4.83 5.55 17340 45.24 42.98 49.43 17004 179.87 170.88 196.51 # 17340 45.72 43.43 49.94 # 17004 137.36 130.49 150.06 17360 130.82 124.28 142.92 17106 394.02 374.32 430.47 # 17360 96.91 92.06 105.87 # 17106 330.02 313.52 360.55 19000 124.94 118.69 136.49 17107 678.20 644.29 740.93 # 19000 45.66 43.38 49.89 # 17107 587.93 558.53 642.31 19001 27.84 26.45 30.42 17108 909.57 864.09 993.70 # 19001 22.59 21.46 24.68 # 17108 812.14 771.53 887.26 19020 454.04 431.34 496.04 17110 106.09 100.79 115.91 # 19020 281.14 267.08 307.14 # 17110 62.63 59.50 68.43 19030 188.46 179.04 205.90 17111 127.96 121.56 139.79 # 19030 81.00 76.95 88.49 # 17111 80.20 76.19 87.62 19100 148.78 141.34 162.54 17250 79.98 75.98 87.38 # 19100 67.11 63.75 73.31 # 17250 36.52 34.69 39.89 19101 336.10 319.30 367.20 17260 97.62 92.74 106.65 # 19101 212.40 201.78 232.05 # 17260 66.58 63.25 72.74 19102 248.30 235.89 271.27 17261 140.93 133.88 153.96 # 19102 105.97 100.67 115.77 # 17261 88.39 83.97 96.57 19103 653.80 621.11 714.28 17262 170.24 161.73 185.99 # 19103 195.77 185.98 213.88 # 17262 112.45 106.83 122.85 19105 2,359.35 2,241.38 2,577.59 17263 187.22 177.86 204.54 # 19105 185.74 176.45 202.92 # 17263 123.69 117.51 135.14 19110 453.03 430.38 494.94 17264 202.14 192.03 220.83 # 19110 312.14 296.53 341.01 # 17264 131.93 125.33 144.13 19112 438.88 416.94 479.48 17266 228.19 216.78 249.30 # 19112 284.14 269.93 310.42 # 17266 151.78 144.19 165.82 19120 456.45 433.63 498.67 17270 147.00 139.65 160.60 # 19120 380.04 361.04 415.20 # 17270 94.94 90.19 103.72 19125 501.97 476.87 548.40 17271 160.40 152.38 175.24 # 19125 420.78 399.74 459.70 # 17271 106.91 101.56 116.79 19126 155.81 148.02 170.22 17272 183.48 174.31 200.46 19260 1,190.31 1,130.79 1,300.41 # 17272 123.78 117.59 135.23 19271 1,652.81 1,570.17 1,805.70 17273 203.77 193.58 222.62 19272 1,818.07 1,727.17 1,986.25 # 17273 138.82 131.88 151.66 19290 183.51 174.33 200.48 17274 241.49 229.42 263.83 # 19290 66.98 63.63 73.17 # 17274 169.85 161.36 185.56 19291 78.87 74.93 86.17 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 8 FSY08 LOCALITY FEE SCHEDULE FOR AREA 26 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 33.02 31.37 36.08 # 20225 123.89 117.70 135.36 19295 119.26 113.30 130.30 20240 236.65 224.82 258.54 19296 5,188.74 4,929.30 5,668.70 20245 641.84 609.75 701.21 # 19296 202.96 192.81 221.73 20250 383.26 364.10 418.72 19297 90.92 86.37 99.33 20251 426.63 405.30 466.10 19298 1,755.38 1,667.61 1,917.75 20500 133.28 126.62 145.61 # 19298 330.19 313.68 360.73 # 20500 104.63 99.40 114.31 19300 566.32 538.00 618.70 20501 153.81 146.12 168.04 # 19300 376.71 357.87 411.55 # 20501 40.14 38.13 43.85 19301 565.25 536.99 617.54 20520 203.79 193.60 222.64 19302 839.20 797.24 916.83 # 20520 148.87 141.43 162.64 19303 869.80 826.31 950.26 20525 526.96 500.61 575.70 19304 537.21 510.35 586.90 # 20525 254.25 241.54 277.77 19305 1,045.67 993.39 1,142.40 20526 79.52 75.54 86.87 19306 1,093.34 1,038.67 1,194.47 # 20526 58.98 56.03 64.43 19307 1,099.02 1,044.07 1,200.68 20550 60.99 57.94 66.63 19316 780.73 741.69 852.94 # 20550 41.41 39.34 45.24 19318 1,152.68 1,095.05 1,259.31 20551 60.18 57.17 65.75 19324 482.26 458.15 526.87 # 20551 43.46 41.29 47.48 19325 648.65 616.22 708.65 20552 55.55 52.77 60.69 19328 489.72 465.23 535.01 # 20552 35.01 33.26 38.25 19330 619.54 588.56 676.84 20553 62.19 59.08 67.94 19340 396.02 376.22 432.65 # 20553 38.79 36.85 42.38 19342 917.81 871.92 1,002.71 20555 326.37 310.05 356.56 19350 925.77 879.48 1,011.40 20600 57.03 54.18 62.31 # 19350 687.44 653.07 751.03 # 20600 41.27 39.21 45.09 19355 742.60 705.47 811.29 20605 62.11 59.00 67.85 # 19355 544.87 517.63 595.27 # 20605 42.53 40.40 46.46 19357 1,551.85 1,474.26 1,695.40 20610 79.47 75.50 86.83 19361 1,599.19 1,519.23 1,747.11 # 20610 50.81 48.27 55.51 19364 2,770.54 2,632.01 3,026.81 20612 61.18 58.12 66.84 19366 1,374.21 1,305.50 1,501.33 # 20612 43.98 41.78 48.05 19367 1,818.60 1,727.67 1,986.82 20615 235.14 223.38 256.89 19368 2,232.75 2,121.11 2,439.28 # 20615 164.45 156.23 179.66 19369 2,055.65 1,952.87 2,245.80 20650 203.40 193.23 222.21 19370 682.01 647.91 745.10 # 20650 159.94 151.94 174.73 19371 786.08 746.78 858.80 20660 267.16 253.80 291.87 19380 767.83 729.44 838.86 # 20660 232.29 220.68 253.78 19396 219.41 208.44 239.71 20661 478.08 454.18 522.31 # 19396 139.65 132.67 152.57 20662 482.56 458.43 527.19 20000 213.23 202.57 232.96 20663 457.40 434.53 499.71 # 20000 160.21 152.20 175.03 20664 754.95 717.20 824.78 20005 309.56 294.08 338.19 20665 136.46 129.64 149.09 # 20005 240.31 228.29 262.53 # 20665 107.80 102.41 117.77 20100 590.65 561.12 645.29 20670 504.03 478.83 550.65 20101 425.48 404.21 464.84 # 20670 160.63 152.60 175.49 # 20101 201.48 191.41 220.12 20680 627.96 596.56 686.04 20102 497.72 472.83 543.75 # 20680 409.22 388.76 447.07 # 20102 242.67 230.54 265.12 20690 496.92 472.07 542.88 20103 600.91 570.86 656.49 20692 914.14 868.43 998.69 # 20103 356.86 339.02 389.87 20693 477.14 453.28 521.27 20150 924.93 878.68 1,010.48 20694 466.90 443.56 510.09 20200 204.61 194.38 223.54 # 20694 349.88 332.39 382.25 # 20200 92.85 88.21 101.44 20802 2,410.85 2,290.31 2,633.86 20205 276.86 263.02 302.47 20805 3,184.25 3,025.04 3,478.80 # 20205 146.95 139.60 160.54 20808 4,139.31 3,932.34 4,522.19 20206 316.47 300.65 345.75 20816 2,545.37 2,418.10 2,780.82 # 20206 65.25 61.99 71.29 20822 2,242.28 2,130.17 2,449.70 20220 220.14 209.13 240.50 20824 2,514.93 2,389.18 2,747.56 # 20220 81.64 77.56 89.19 20827 2,290.58 2,176.05 2,502.46 20225 942.99 895.84 1,030.22 20838 2,380.66 2,261.63 2,600.87 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 26 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 653.08 620.43 713.49 # 21076 882.33 838.21 963.94 # 20900 484.01 459.81 528.78 21077 2,509.42 2,383.95 2,741.54 20902 627.23 595.87 685.25 # 21077 2,224.77 2,113.53 2,430.56 20910 444.17 421.96 485.25 21079 1,726.33 1,640.01 1,886.01 20912 501.95 476.85 548.38 # 21079 1,482.27 1,408.16 1,619.38 20920 414.24 393.53 452.56 21080 1,964.97 1,866.72 2,146.73 20922 620.98 589.93 678.42 # 21080 1,672.20 1,588.59 1,826.88 # 20922 495.84 471.05 541.71 21081 1,790.92 1,701.37 1,956.58 20924 522.38 496.26 570.70 # 21081 1,517.73 1,441.84 1,658.12 20926 447.31 424.94 488.68 21082 1,644.67 1,562.44 1,796.81 20931 115.14 109.38 125.79 # 21082 1,400.13 1,330.12 1,529.64 20937 175.03 166.28 191.22 21083 1,569.77 1,491.28 1,714.97 20938 190.54 181.01 208.16 # 21083 1,295.14 1,230.38 1,414.94 20950 314.97 299.22 344.10 21084 1,791.17 1,701.61 1,956.85 # 20950 95.27 90.51 104.09 # 21084 1,489.32 1,414.85 1,627.08 20955 2,573.97 2,445.27 2,812.06 21085 717.64 681.76 784.02 20956 2,730.35 2,593.83 2,982.90 # 21085 600.15 570.14 655.66 20957 2,535.50 2,408.73 2,770.04 21086 1,862.63 1,769.50 2,034.93 20962 2,721.48 2,585.41 2,973.22 # 21086 1,652.96 1,570.31 1,805.86 20969 2,864.57 2,721.34 3,129.54 21087 1,845.52 1,753.24 2,016.23 20970 2,861.62 2,718.54 3,126.32 # 21087 1,640.63 1,558.60 1,792.39 20972 2,557.68 2,429.80 2,794.27 21100 800.08 760.08 874.09 20973 2,752.59 2,614.96 3,007.20 # 21100 415.13 394.37 453.53 20974 64.96 61.71 70.97 21110 765.39 727.12 836.19 # 20974 49.68 47.20 54.28 # 21110 657.45 624.58 718.27 20975 182.62 173.49 199.51 21116 193.30 183.64 211.19 20979 58.57 55.64 63.99 # 21116 43.33 41.16 47.33 # 20979 37.55 35.67 41.02 21120 676.20 642.39 738.75 20982 4,805.15 4,564.89 5,249.62 # 21120 530.53 504.00 579.60 # 20982 410.18 389.67 448.12 21121 783.65 744.47 856.14 20985 149.90 142.41 163.77 # 21121 665.21 631.95 726.74 21010 734.54 697.81 802.48 21122 741.23 704.17 809.80 21015 439.63 417.65 480.30 21123 861.73 818.64 941.44 21025 1,020.15 969.14 1,114.51 21125 3,244.48 3,082.26 3,544.60 # 21025 860.15 817.14 939.71 # 21125 748.96 711.51 818.24 21026 610.96 580.41 667.47 21127 3,528.50 3,352.08 3,854.89 # 21026 504.93 479.68 551.63 # 21127 880.15 836.14 961.56 21029 769.90 731.41 841.12 21137 757.34 719.47 827.39 # 21029 640.94 608.89 700.22 21138 913.34 867.67 997.82 21030 507.43 482.06 554.37 21139 987.25 937.89 1,078.57 # 21030 416.68 395.85 455.23 21141 1,356.30 1,288.49 1,481.76 21031 393.60 373.92 430.01 21142 1,319.63 1,253.65 1,441.70 # 21031 298.56 283.63 326.17 21143 1,398.53 1,328.60 1,527.89 21032 401.70 381.62 438.86 21145 1,556.71 1,478.87 1,700.70 # 21032 293.76 279.07 320.93 21146 1,539.79 1,462.80 1,682.22 21034 1,366.26 1,297.95 1,492.64 21147 1,669.29 1,585.83 1,823.70 # 21034 1,197.19 1,137.33 1,307.93 21150 1,783.96 1,694.76 1,948.97 21040 509.34 483.87 556.45 21151 1,902.99 1,807.84 2,079.02 # 21040 408.08 387.68 445.83 21154 2,139.65 2,032.67 2,337.57 21044 891.85 847.26 974.35 21155 2,439.56 2,317.58 2,665.22 21045 1,232.60 1,170.97 1,346.62 21159 2,817.29 2,676.43 3,077.89 21046 1,105.12 1,049.86 1,207.34 21160 2,977.56 2,828.68 3,252.98 21047 1,323.53 1,257.35 1,445.95 21172 1,748.74 1,661.30 1,910.50 21048 1,122.79 1,066.65 1,226.65 21175 2,068.94 1,965.49 2,260.31 21049 1,271.44 1,207.87 1,389.05 21179 1,480.49 1,406.47 1,617.44 21050 870.78 827.24 951.33 21180 1,676.85 1,593.01 1,831.96 21060 801.71 761.62 875.86 21181 738.29 701.38 806.59 21070 656.77 623.93 717.52 21182 2,040.57 1,938.54 2,229.32 21073 392.39 372.77 428.69 21183 2,339.23 2,222.27 2,555.61 # 21073 240.03 228.03 262.23 21184 2,422.49 2,301.37 2,646.58 21076 1,017.97 967.07 1,112.13 21188 1,678.12 1,594.21 1,833.34 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 10 FSY08 LOCALITY FEE SCHEDULE FOR AREA 26 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 1,258.05 1,195.15 1,374.42 21345 823.93 782.73 900.14 21194 1,433.16 1,361.50 1,565.73 # 21345 666.32 633.00 727.95 21195 1,375.78 1,306.99 1,503.04 21346 981.94 932.84 1,072.77 21196 1,490.35 1,415.83 1,628.20 21347 1,179.68 1,120.70 1,288.81 21198 1,172.17 1,113.56 1,280.59 21348 1,213.28 1,152.62 1,325.51 21199 1,021.63 970.55 1,116.13 21355 450.88 428.34 492.59 21206 1,139.26 1,082.30 1,244.65 # 21355 321.92 305.82 351.69 21208 1,748.86 1,661.42 1,910.63 21356 515.07 489.32 562.72 # 21208 843.31 801.14 921.31 # 21356 383.73 364.54 419.22 21209 841.89 799.80 919.77 21360 539.21 512.25 589.09 # 21209 661.83 628.74 723.05 21365 1,105.78 1,050.49 1,208.06 21210 2,071.62 1,968.04 2,263.25 21366 1,244.33 1,182.11 1,359.43 # 21210 844.64 802.41 922.77 21385 728.58 692.15 795.97 21215 3,522.50 3,346.38 3,848.34 21386 672.70 639.07 734.93 # 21215 878.92 834.97 960.22 21387 775.02 736.27 846.71 21230 786.16 746.85 858.88 21390 767.84 729.45 838.87 21235 750.58 713.05 820.01 21395 969.82 921.33 1,059.53 # 21235 574.82 546.08 627.99 21400 182.05 172.95 198.89 21240 1,135.35 1,078.58 1,240.37 # 21400 146.71 139.37 160.28 21242 1,046.70 994.37 1,143.53 21401 495.47 470.70 541.31 21243 1,696.47 1,611.65 1,853.40 # 21401 292.49 277.87 319.55 21244 1,068.80 1,015.36 1,167.66 21406 549.68 522.20 600.53 21245 1,169.67 1,111.19 1,277.87 21407 645.63 613.35 705.35 # 21245 927.52 881.14 1,013.31 21408 877.65 833.77 958.84 21246 881.54 837.46 963.08 21421 746.14 708.83 815.15 21247 1,646.50 1,564.18 1,798.81 # 21421 643.93 611.73 703.49 21248 1,077.66 1,023.78 1,177.35 21422 692.94 658.29 757.03 # 21248 890.43 845.91 972.80 21423 813.41 772.74 888.65 21249 1,502.42 1,427.30 1,641.40 21431 778.57 739.64 850.59 # 21249 1,259.80 1,196.81 1,376.33 21432 685.94 651.64 749.39 21255 1,429.68 1,358.20 1,561.93 21433 1,681.08 1,597.03 1,836.58 21256 1,165.10 1,106.85 1,272.88 21435 1,328.90 1,262.46 1,451.83 21260 1,262.12 1,199.01 1,378.86 21436 1,893.43 1,798.76 2,068.57 21261 2,217.13 2,106.27 2,422.21 21440 536.73 509.89 586.37 21263 1,944.23 1,847.02 2,124.07 # 21440 451.72 429.13 493.50 21267 1,622.07 1,540.97 1,772.12 21445 761.80 723.71 832.27 21268 1,847.12 1,754.76 2,017.97 # 21445 637.63 605.75 696.61 21270 933.60 886.92 1,019.96 21450 561.71 533.62 613.66 # 21270 702.91 667.76 767.92 # 21450 482.91 458.76 527.57 21275 812.85 772.21 888.04 21451 743.89 706.70 812.71 21280 530.35 503.83 579.40 # 21451 642.16 610.05 701.56 21282 357.55 339.67 390.62 21452 687.46 653.09 751.05 21295 182.01 172.91 198.85 # 21452 343.58 326.40 375.36 21296 420.10 399.10 458.97 21453 857.13 814.27 936.41 21310 123.96 117.76 135.42 # 21453 781.67 742.59 853.98 # 21310 27.96 26.56 30.54 21454 562.36 534.24 614.38 21315 280.46 266.44 306.41 21461 1,928.18 1,831.77 2,106.54 # 21315 153.89 146.20 168.13 # 21461 955.76 907.97 1,044.17 21320 266.88 253.54 291.57 21462 2,102.54 1,997.41 2,297.02 # 21320 141.74 134.65 154.85 # 21462 1,039.85 987.86 1,136.04 21325 523.84 497.65 572.30 21465 924.94 878.69 1,010.49 21330 629.64 598.16 687.88 21470 1,193.54 1,133.86 1,303.94 21335 766.02 727.72 836.88 21480 102.07 96.97 111.52 21336 682.47 648.35 745.60 # 21480 31.86 30.27 34.81 21337 415.60 394.82 454.04 21485 660.94 627.89 722.07 # 21337 292.85 278.21 319.94 # 21485 576.40 547.58 629.72 21338 833.80 792.11 910.93 21490 931.81 885.22 1,018.00 21339 889.91 845.41 972.22 21495 693.89 659.20 758.08 21340 805.28 765.02 879.77 21497 664.87 631.63 726.37 21343 1,213.79 1,153.10 1,326.07 # 21497 576.99 548.14 630.36 21344 1,528.38 1,451.96 1,669.75 21501 458.58 435.65 501.00 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31146 PAGE 11 FSY08 LOCALITY FEE SCHEDULE FOR AREA 26 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 323.89 307.70 353.86 # 22310 260.69 247.66 284.81 21502 533.43 506.76 582.77 22315 873.30 829.64 954.09 21510 487.20 462.84 532.27 # 22315 758.67 720.74 828.85 21550 267.01 253.66 291.71 22318 1,594.81 1,515.07 1,742.33 # 21550 160.98 152.93 175.87 22319 1,746.66 1,659.33 1,908.23 21555 440.90 418.86 481.69 22325 1,388.54 1,319.11 1,516.98 # 21555 329.14 312.68 359.58 22326 1,454.23 1,381.52 1,588.75 21556 413.75 393.06 452.02 22327 1,434.78 1,363.04 1,567.50 21557 581.04 551.99 634.79 22328 286.79 272.45 313.32 21600 560.07 532.07 611.88 22505 125.68 119.40 137.31 21610 1,073.74 1,020.05 1,173.06 22520 2,895.81 2,751.02 3,163.67 21615 689.08 654.63 752.82 # 22520 606.63 576.30 662.75 21616 844.25 802.04 922.35 22521 2,763.80 2,625.61 3,019.45 21620 537.60 510.72 587.33 # 22521 573.47 544.80 626.52 21627 566.07 537.77 618.44 22522 252.49 239.87 275.85 21630 1,275.62 1,211.84 1,393.62 22523 629.30 597.84 687.52 21632 1,255.63 1,192.85 1,371.78 22524 602.92 572.77 658.69 21685 999.10 949.15 1,091.52 22525 277.03 263.18 302.66 21700 437.96 416.06 478.47 22526 2,481.18 2,357.12 2,710.69 21705 626.02 594.72 683.93 # 22526 347.22 329.86 379.34 21720 385.91 366.61 421.60 22527 2,054.01 1,951.31 2,244.01 21725 539.55 512.57 589.46 # 22527 157.89 150.00 172.50 21740 1,083.87 1,029.68 1,184.13 22532 1,723.42 1,637.25 1,882.84 21750 720.88 684.84 787.57 22533 1,607.67 1,527.29 1,756.38 21800 101.34 96.27 110.71 22534 376.20 357.39 411.00 # 21800 102.77 97.63 112.27 22548 1,852.69 1,760.06 2,024.07 21805 264.67 251.44 289.16 22554 1,306.17 1,240.86 1,426.99 21810 518.05 492.15 565.97 22556 1,655.76 1,572.97 1,808.92 21820 138.02 131.12 150.79 22558 1,504.90 1,429.66 1,644.11 21825 583.70 554.52 637.70 22585 349.07 331.62 381.36 21920 261.09 248.04 285.25 22590 1,538.24 1,461.33 1,680.53 # 21920 156.97 149.12 171.49 22595 1,464.63 1,391.40 1,600.11 21925 428.72 407.28 468.37 22600 1,255.73 1,192.94 1,371.88 # 21925 335.11 318.35 366.10 22610 1,240.91 1,178.86 1,355.69 21930 478.45 454.53 522.71 22612 1,597.76 1,517.87 1,745.55 # 21930 369.08 350.63 403.22 22614 407.35 386.98 445.03 21935 1,151.91 1,094.31 1,258.46 22630 1,541.45 1,464.38 1,684.04 22010 905.58 860.30 989.35 22632 331.05 314.50 361.68 22015 899.54 854.56 982.74 22800 1,366.36 1,298.04 1,492.75 22100 821.64 780.56 897.64 22802 2,162.17 2,054.06 2,362.17 22101 820.08 779.08 895.94 22804 2,502.00 2,376.90 2,733.44 22102 822.90 781.76 899.02 22808 1,836.74 1,744.90 2,006.64 22103 145.92 138.62 159.41 22810 2,051.54 1,948.96 2,241.30 22110 1,007.71 957.32 1,100.92 22812 2,250.09 2,137.59 2,458.23 22112 1,002.56 952.43 1,095.29 22818 2,248.53 2,136.10 2,456.52 22114 1,005.27 955.01 1,098.26 22819 2,543.91 2,416.71 2,779.22 22116 146.18 138.87 159.70 22830 821.19 780.13 897.15 22206 2,337.25 2,220.39 2,553.45 22840 796.63 756.80 870.32 22207 2,308.87 2,193.43 2,522.44 22842 796.96 757.11 870.68 22208 582.20 553.09 636.05 22843 842.32 800.20 920.23 22210 1,769.21 1,680.75 1,932.86 22844 1,037.68 985.80 1,133.67 22212 1,463.96 1,390.76 1,599.37 22845 761.29 723.23 831.71 22214 1,480.28 1,406.27 1,617.21 22846 791.27 751.71 864.47 22216 382.45 363.33 417.83 22847 869.39 825.92 949.81 22220 1,600.73 1,520.69 1,748.79 22848 377.64 358.76 412.57 22222 1,445.27 1,373.01 1,578.96 22849 1,314.42 1,248.70 1,436.01 22224 1,579.57 1,500.59 1,725.68 22850 726.14 689.83 793.30 22226 380.54 361.51 415.74 22851 422.85 401.71 461.97 22305 191.56 181.98 209.28 22852 695.36 660.59 759.68 # 22305 173.89 165.20 189.98 22855 1,114.58 1,058.85 1,217.68 22310 283.14 268.98 309.33 22857 1,760.07 1,672.07 1,922.88 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 26 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 2,071.65 1,968.07 2,263.28 23415 756.21 718.40 826.16 22865 2,018.22 1,917.31 2,204.91 23420 1,079.78 1,025.79 1,179.66 22900 399.79 379.80 436.77 23430 761.79 723.70 832.26 23000 567.16 538.80 619.62 23440 785.15 745.89 857.77 # 23000 369.91 351.41 404.12 23450 979.37 930.40 1,069.96 23020 707.12 671.76 772.52 23455 1,041.43 989.36 1,137.76 23030 464.99 441.74 508.00 23460 1,128.03 1,071.63 1,232.37 # 23030 264.87 251.63 289.37 23462 1,101.45 1,046.38 1,203.34 23031 454.41 431.69 496.44 23465 1,146.46 1,089.14 1,252.51 # 23031 228.98 217.53 250.16 23466 1,131.93 1,075.33 1,236.63 23035 713.94 678.24 779.98 23470 1,249.52 1,187.04 1,365.10 23040 736.35 699.53 804.46 23472 1,535.80 1,459.01 1,677.86 23044 586.42 557.10 640.67 23480 845.09 802.84 923.27 23065 215.73 204.94 235.68 23485 988.23 938.82 1,079.64 # 23065 166.05 157.75 181.41 23490 835.58 793.80 912.87 23066 535.79 509.00 585.35 23491 1,045.82 993.53 1,142.56 # 23066 348.57 331.14 380.81 23500 215.85 205.06 235.82 23075 270.57 257.04 295.60 # 23500 209.16 198.70 228.51 # 23075 178.39 169.47 194.89 23505 350.95 333.40 383.41 23076 566.81 538.47 619.24 # 23505 328.02 311.62 358.36 23077 1,178.64 1,119.71 1,287.67 23515 696.84 662.00 761.30 23100 500.27 475.26 546.55 23520 222.32 211.20 242.88 23101 463.23 440.07 506.08 # 23520 221.37 210.30 241.85 23105 652.82 620.18 713.21 23525 350.28 332.77 382.69 23106 492.43 467.81 537.98 # 23525 323.53 307.35 353.45 23107 679.44 645.47 742.29 23530 563.95 535.75 616.11 23120 576.94 548.09 630.30 23532 636.78 604.94 695.68 23125 717.32 681.45 783.67 23540 221.11 210.05 241.56 23130 623.62 592.44 681.31 # 23540 210.60 200.07 230.08 23140 521.09 495.04 569.30 23545 316.26 300.45 345.52 23145 704.24 669.03 769.38 # 23545 284.74 270.50 311.08 23146 632.41 600.79 690.91 23550 585.79 556.50 639.98 23150 663.50 630.33 724.88 23552 674.56 640.83 736.95 23155 804.08 763.88 878.46 23570 229.65 218.17 250.90 23156 688.52 654.09 752.20 # 23570 230.13 218.62 251.41 23170 546.58 519.25 597.14 23575 388.98 369.53 424.96 23172 565.09 536.84 617.37 # 23575 363.19 345.03 396.78 23174 769.44 730.97 840.62 23585 925.12 878.86 1,010.69 23180 723.96 687.76 790.92 23600 325.80 309.51 355.94 23182 697.12 662.26 761.60 # 23600 291.89 277.30 318.90 23184 780.37 741.35 852.55 23605 474.86 451.12 518.79 23190 568.29 539.88 620.86 # 23605 430.91 409.36 470.76 23195 762.24 724.13 832.75 23615 877.71 833.82 958.89 23200 882.74 838.60 964.39 23616 1,341.53 1,274.45 1,465.62 23210 925.68 879.40 1,011.31 23620 266.42 253.10 291.07 23220 1,092.86 1,038.22 1,193.95 # 23620 245.40 233.13 268.10 23221 1,273.73 1,210.04 1,391.55 23625 384.53 365.30 420.10 23222 1,709.52 1,624.04 1,867.65 # 23625 356.35 338.53 389.31 23330 241.09 229.04 263.40 23630 736.95 700.10 805.12 # 23330 154.16 146.45 168.42 23650 297.91 283.01 325.46 23331 604.44 574.22 660.35 # 23650 262.57 249.44 286.86 23332 904.85 859.61 988.55 23655 382.73 363.59 418.13 23350 184.71 175.47 201.79 23660 593.31 563.64 648.19 # 23350 52.89 50.25 57.79 23665 424.27 403.06 463.52 23395 1,307.35 1,241.98 1,428.28 # 23665 395.61 375.83 432.20 23397 1,167.82 1,109.43 1,275.84 23670 817.95 777.05 893.61 23400 997.35 947.48 1,089.60 23675 555.78 527.99 607.19 23405 647.11 614.75 706.96 # 23675 508.49 483.07 555.53 23406 805.07 764.82 879.54 23680 899.32 854.35 982.50 23410 920.91 874.86 1,006.09 23700 200.29 190.28 218.82 23412 978.34 929.42 1,068.83 23800 1,045.03 992.78 1,141.70 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 26 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 1,231.37 1,169.80 1,345.27 24343 721.06 685.01 787.76 23900 1,348.11 1,280.70 1,472.81 24344 1,110.90 1,055.36 1,213.66 23920 1,095.85 1,041.06 1,197.22 24345 717.09 681.24 783.43 23921 457.88 434.99 500.24 24346 1,107.51 1,052.13 1,209.95 23930 386.95 367.60 422.74 24357 459.24 436.28 501.72 # 23930 219.79 208.80 240.12 24358 536.13 509.32 585.72 23931 317.43 301.56 346.79 24359 650.23 617.72 710.38 # 23931 165.55 157.27 180.86 24360 916.57 870.74 1,001.35 23935 515.50 489.73 563.19 24361 1,029.78 978.29 1,125.03 24000 482.46 458.34 527.09 24362 990.25 940.74 1,081.85 24006 726.42 690.10 793.62 24363 1,498.41 1,423.49 1,637.01 24065 254.28 241.57 277.81 24365 656.65 623.82 717.39 # 24065 165.92 157.62 181.26 24366 702.55 667.42 767.53 24066 620.19 589.18 677.56 24400 842.84 800.70 920.81 # 24066 401.45 381.38 438.59 24410 1,071.65 1,018.07 1,170.78 24075 503.31 478.14 549.86 24420 998.74 948.80 1,091.12 # 24075 315.13 299.37 344.28 24430 1,049.75 997.26 1,146.85 24076 477.59 453.71 521.77 24435 1,081.40 1,027.33 1,181.43 24077 820.54 779.51 896.44 24470 674.39 640.67 736.77 24100 407.03 386.68 444.68 24495 689.19 654.73 752.94 24101 511.13 485.57 558.41 24498 895.22 850.46 978.03 24102 629.84 598.35 688.10 24500 352.94 335.29 385.58 24105 348.58 331.15 380.82 # 24500 309.96 294.46 338.63 24110 595.56 565.78 650.65 24505 508.65 483.22 555.70 24115 678.46 644.54 741.22 # 24505 457.06 434.21 499.34 24116 888.62 844.19 970.82 24515 899.14 854.18 982.31 24120 534.44 507.72 583.88 24516 886.44 842.12 968.44 24125 603.71 573.52 659.55 24530 380.01 361.01 415.16 24126 644.99 612.74 704.65 # 24530 334.63 317.90 365.59 24130 520.09 494.09 568.20 24535 630.78 599.24 689.13 24134 781.06 742.01 853.31 # 24535 578.72 549.78 632.25 24136 643.87 611.68 703.43 24538 768.25 729.84 839.32 24138 674.68 640.95 737.09 24545 911.21 865.65 995.50 24140 751.58 714.00 821.10 24546 1,090.11 1,035.60 1,190.94 24145 635.78 603.99 694.59 24560 319.66 303.68 349.23 24147 665.23 631.97 726.77 # 24560 272.37 258.75 297.56 24149 1,165.29 1,107.03 1,273.08 24565 526.63 500.30 575.35 24150 994.30 944.59 1,086.28 # 24565 479.34 455.37 523.68 24151 1,150.94 1,093.39 1,257.40 24566 707.71 672.32 773.17 24152 736.43 699.61 804.55 24575 759.95 721.95 830.24 24153 680.76 646.72 743.73 24576 336.54 319.71 367.67 24155 857.12 814.26 936.40 # 24576 294.51 279.78 321.75 24160 620.74 589.70 678.16 24577 545.20 517.94 595.63 24164 509.08 483.63 556.17 # 24577 496.48 471.66 542.41 24200 215.59 204.81 235.53 24579 854.18 811.47 933.19 # 24200 139.65 132.67 152.57 24582 805.42 765.15 879.92 24201 604.63 574.40 660.56 24586 1,121.49 1,065.42 1,225.23 # 24201 372.51 353.88 406.96 24587 1,112.63 1,057.00 1,215.55 24220 198.40 188.48 216.75 24600 373.35 354.68 407.88 # 24220 69.44 65.97 75.87 # 24600 327.02 310.67 357.27 24300 415.36 394.59 453.78 24605 465.73 442.44 508.81 24301 769.56 731.08 840.74 24615 733.77 697.08 801.64 24305 594.24 564.53 649.21 24620 561.33 533.26 613.25 24310 487.52 463.14 532.61 24635 868.34 824.92 948.66 24320 778.18 739.27 850.16 24640 126.85 120.51 138.59 24330 735.54 698.76 803.57 # 24640 84.82 80.58 92.67 24331 808.45 768.03 883.23 24650 260.39 247.37 284.48 24332 613.60 582.92 670.36 # 24650 225.52 214.24 246.38 24340 630.35 598.83 688.65 24655 444.89 422.65 486.05 24341 734.56 697.83 802.50 # 24655 398.56 378.63 435.42 24342 806.53 766.20 881.13 24665 666.87 633.53 728.56 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 26 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 750.51 712.98 819.93 25251 728.35 691.93 795.72 24670 291.06 276.51 317.99 25259 414.36 393.64 452.69 # 24670 252.37 239.75 275.71 25260 783.76 744.57 856.26 24675 464.92 441.67 507.92 25263 775.71 736.92 847.46 # 24675 420.98 399.93 459.92 25265 905.83 860.54 989.62 24685 670.61 637.08 732.64 25270 647.89 615.50 707.83 24800 818.42 777.50 894.13 25272 719.62 683.64 786.19 24802 1,010.99 960.44 1,104.51 25274 828.88 787.44 905.56 24900 720.98 684.93 787.67 25275 685.37 651.10 748.77 24920 710.91 675.36 776.66 25280 723.02 686.87 789.90 24925 550.88 523.34 601.84 25290 678.06 644.16 740.78 24930 748.64 711.21 817.89 25295 679.45 645.48 742.30 24931 783.11 743.95 855.54 25300 710.98 675.43 776.74 24935 1,078.16 1,024.25 1,177.89 25301 677.27 643.41 739.92 25000 396.98 377.13 433.70 25310 779.84 740.85 851.98 25001 341.25 324.19 372.82 25312 876.63 832.80 957.72 25020 632.61 600.98 691.13 25315 932.76 886.12 1,019.04 25023 1,170.43 1,111.91 1,278.70 25316 1,075.47 1,021.70 1,174.96 25024 761.19 723.13 831.60 25320 990.56 941.03 1,082.18 25025 1,147.21 1,089.85 1,253.33 25332 864.53 821.30 944.50 25028 553.80 526.11 605.03 25335 999.06 949.11 1,091.48 25031 438.61 416.68 479.18 25337 921.09 875.04 1,006.30 25035 761.76 723.67 832.22 25350 845.45 803.18 923.66 25040 598.73 568.79 654.11 25355 929.14 882.68 1,015.08 25065 255.24 242.48 278.85 25360 826.32 785.00 902.75 # 25065 167.36 158.99 182.84 25365 1,084.26 1,030.05 1,184.56 25066 426.53 405.20 465.98 25370 1,158.85 1,100.91 1,266.05 25075 369.15 350.69 403.29 25375 1,132.90 1,076.26 1,237.70 25076 523.33 497.16 571.73 25390 939.22 892.26 1,026.10 25077 827.22 785.86 903.74 25391 1,166.95 1,108.60 1,274.89 25085 501.23 476.17 547.60 25392 1,165.32 1,107.05 1,273.11 25100 372.65 354.02 407.12 25393 1,310.27 1,244.76 1,431.47 25101 433.73 412.04 473.85 25394 782.99 743.84 855.42 25105 528.66 502.23 577.56 25400 984.40 935.18 1,075.46 25107 641.05 609.00 700.35 25405 1,219.22 1,158.26 1,332.00 25109 518.52 492.59 566.48 25415 1,150.99 1,093.44 1,257.46 25110 413.13 392.47 451.34 25420 1,346.73 1,279.39 1,471.30 25111 335.66 318.88 366.71 25425 1,254.13 1,191.42 1,370.13 25112 405.06 384.81 442.53 25426 1,265.57 1,202.29 1,382.63 25115 897.19 852.33 980.18 25430 717.67 681.79 784.06 25116 754.78 717.04 824.60 25431 808.11 767.70 882.86 25118 412.25 391.64 450.39 25440 809.76 769.27 884.66 25119 545.77 518.48 596.25 25441 958.00 910.10 1,046.62 25120 657.48 624.61 718.30 25442 823.40 782.23 899.56 25125 739.92 702.92 808.36 25443 792.37 752.75 865.66 25126 757.39 719.52 827.45 25444 841.87 799.78 919.75 25130 477.44 453.57 521.61 25445 740.93 703.88 809.46 25135 589.16 559.70 643.66 25446 1,201.08 1,141.03 1,312.18 25136 522.81 496.67 571.17 25447 828.22 786.81 904.83 25145 669.18 635.72 731.08 25449 1,056.06 1,003.26 1,153.75 25150 618.11 587.20 675.28 25450 655.83 623.04 716.50 25151 740.88 703.84 809.42 25455 787.11 747.75 859.91 25170 990.47 940.95 1,082.09 25490 866.03 822.73 946.14 25210 520.37 494.35 568.50 25491 908.70 863.27 992.76 25215 671.08 637.53 733.16 25492 1,070.49 1,016.97 1,169.52 25230 463.51 440.33 506.38 25500 262.98 249.83 287.30 25240 480.84 456.80 525.32 # 25500 231.94 220.34 253.39 25246 200.99 190.94 219.58 25505 509.51 484.03 556.63 # 25246 77.29 73.43 84.44 # 25505 462.23 439.12 504.99 25248 504.75 479.51 551.44 25515 685.52 651.24 748.93 25250 536.16 509.35 585.75 25520 556.04 528.24 607.48 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 15 FSY08 LOCALITY FEE SCHEDULE FOR AREA 26 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 523.56 497.38 571.99 25929 580.93 551.88 634.66 25525 846.46 804.14 924.76 25931 786.00 746.70 858.71 25526 1,052.73 1,000.09 1,150.10 26010 289.68 275.20 316.48 25530 258.65 245.72 282.58 # 26010 134.93 128.18 147.41 # 25530 225.21 213.95 246.04 26011 447.90 425.51 489.34 25535 487.32 462.95 532.39 # 26011 189.99 180.49 207.56 # 25535 452.93 430.28 494.82 26020 437.99 416.09