1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 1 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 EFFECTIVE JANUARY 1, 2008-JUNE 30, 2008 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G0101 40.99 38.94 44.78 # G0268 32.60 30.97 35.62 G0102 23.99 22.79 26.21 G0270 27.60 26.22 30.15 # G0102 9.09 8.64 9.94 # G0270 27.11 25.75 29.61 G0104 154.30 146.59 168.58 G0271 15.32 14.55 16.73 # G0104 62.92 59.77 68.74 # G0271 14.83 14.09 16.20 G0105 445.51 423.23 486.71 G0275 14.83 14.09 16.20 # G0105 216.05 205.25 236.04 G0278 14.83 14.09 16.20 G0105 53 154.30 146.59 168.58 G0281 12.46 11.84 13.62 # G0105 53 62.92 59.77 68.74 G0283 12.46 11.84 13.62 G0106 223.97 212.77 244.69 G0288 293.22 278.56 320.34 G0106 TC 172.50 163.88 188.46 G0289 90.76 86.22 99.15 G0106 26 51.47 48.90 56.24 G0308 801.06 761.01 875.16 G0108 35.47 33.70 38.76 G0309 654.78 622.04 715.35 G0109 20.07 19.07 21.93 G0310 510.86 485.32 558.12 G0117 52.71 50.07 57.58 G0311 549.55 522.07 600.38 G0118 36.90 35.06 40.32 G0312 451.49 428.92 493.26 C G0120 219.50 208.53 239.81 G0313 353.41 335.74 386.10 C G0120 TC 168.03 159.63 183.57 G0314 486.29 461.98 531.28 G0120 26 51.47 48.90 56.24 G0315 399.09 379.14 436.01 G0121 445.51 423.23 486.71 G0316 309.09 293.64 337.69 # G0121 216.05 205.25 236.04 G0317 307.04 291.69 335.44 G0121 53 154.30 146.59 168.58 G0318 251.06 238.51 274.29 # G0121 53 62.92 59.77 68.74 G0319 195.48 185.71 213.57 G0124 27.89 26.50 30.48 G0320 618.52 587.59 675.73 G0127 22.00 20.90 24.04 G0321 433.61 411.93 473.72 # G0127 9.09 8.64 9.94 G0322 377.73 358.84 412.67 G0128 3.95 3.75 4.31 G0323 237.16 225.30 259.10 G0130 44.46 42.24 48.58 G0324 22.35 21.23 24.41 G0130 TC 33.30 31.64 36.39 G0325 13.05 12.40 14.26 G0130 26 11.16 10.60 12.19 G0326 15.12 14.36 16.51 G0141 27.89 26.50 30.48 G0327 8.41 7.99 9.19 G0166 203.22 193.06 222.02 G0329 9.62 9.14 10.51 G0168 103.78 98.59 113.38 G0332 97.84 92.95 106.89 # G0168 26.79 25.45 29.27 G0339 3,915.07 3,719.32 4,277.22 G0179 53.41 50.74 58.35 G0340 2,658.17 2,525.26 2,904.05 G0180 69.04 65.59 75.43 G0341 375.15 356.39 409.85 G0181 117.91 112.01 128.81 G0342 700.53 665.50 765.33 G0182 122.87 116.73 134.24 G0343 1,160.68 1,102.65 1,268.05 G0186 368.26 349.85 402.33 G0344 104.13 98.92 113.76 G0202 165.02 156.77 180.29 # G0344 70.86 67.32 77.42 G0202 TC 128.57 122.14 140.46 G0364 13.78 13.09 15.05 G0202 26 36.45 34.63 39.82 # G0364 9.31 8.84 10.17 G0204 186.03 176.73 203.24 C G0365 205.15 194.89 224.12 G0204 TC 140.49 133.47 153.49 C G0365 TC 192.10 182.50 209.88 G0204 26 45.54 43.26 49.75 G0365 26 13.04 12.39 14.25 G0206 148.43 141.01 162.16 G0366 27.38 26.01 29.91 G0206 TC 111.98 106.38 122.34 G0367 18.29 17.38 19.99 G0206 26 36.45 34.63 39.82 G0368 9.09 8.64 9.94 G0237 17.29 16.43 18.89 G0372 17.04 16.19 18.62 G0238 18.29 17.38 19.99 # G0372 8.59 8.16 9.38 G0239 16.30 15.49 17.81 G0389 142.02 134.92 155.16 G0245 71.37 67.80 77.97 G0389 TC 111.39 105.82 121.69 # G0245 46.04 43.74 50.30 G0389 26 30.63 29.10 33.47 G0246 43.48 41.31 47.51 G0392 2,944.44 2,797.22 3,216.80 # G0246 23.61 22.43 25.79 # G0392 513.81 488.12 561.34 G0247 47.53 45.15 51.92 G0393 2,250.34 2,137.82 2,458.49 # G0247 26.68 25.35 29.15 # G0393 329.78 313.29 360.28 G0248 249.03 236.58 272.07 G0396 32.09 30.49 35.06 G0249 182.97 173.82 199.89 # G0396 30.10 28.60 32.89 G0250 9.98 9.48 10.90 G0397 62.39 59.27 68.16 G0268 53.96 51.26 58.95 # G0397 59.91 56.91 65.45 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 2 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G9041 25.50 24.23 27.86 10022 162.45 154.33 177.48 G9042 11.69 11.11 12.78 # 10022 66.10 62.80 72.22 G9043 11.69 11.11 12.78 10040 100.48 95.46 109.78 G9044 10.20 9.69 11.14 # 10040 86.08 81.78 94.05 M0064 43.99 41.79 48.06 10060 111.34 105.77 121.64 # M0064 17.67 16.79 19.31 # 10060 93.96 89.26 102.65 P3001 27.89 26.50 30.48 10061 186.03 176.73 203.24 Q0035 24.89 23.65 27.20 # 10061 163.68 155.50 178.83 Q0035 TC 16.30 15.49 17.81 10080 187.13 177.77 204.44 Q0035 26 8.59 8.16 9.38 # 10080 98.72 93.78 107.85 Q0091 48.67 46.24 53.18 10081 278.48 264.56 304.24 # Q0091 19.36 18.39 21.15 # 10081 163.75 155.56 178.89 Q0092 20.07 19.07 21.93 10120 147.29 139.93 160.92 R0070 191.66 182.08 209.39 # 10120 92.66 88.03 101.23 R0075 191.66 182.08 209.39 10121 275.17 261.41 300.62 0016T 368.26 349.85 402.33 # 10121 186.27 176.96 203.50 0030T 26.31 24.99 28.74 10140 157.76 149.87 172.35 0067T 533.23 506.57 582.56 # 10140 121.50 115.43 132.74 C 0067T TC 238.10 226.20 260.13 10160 130.42 123.90 142.49 0067T 26 67.92 64.52 74.20 # 10160 98.63 93.70 107.76 0073T 777.43 738.56 849.34 10180 240.85 228.81 263.13 0075T 1,205.45 1,145.18 1,316.96 # 10180 179.76 170.77 196.39 0075T 26 904.50 859.28 988.17 11000 54.58 51.85 59.63 0076T 397.80 377.91 434.60 # 11000 31.74 30.15 34.67 0076T 26 90.45 85.93 98.82 11001 22.48 21.36 24.56 0078T 1,489.48 1,415.01 1,627.26 # 11001 16.02 15.22 17.50 0079T 143.45 136.28 156.72 11004 564.49 536.27 616.71 0080T 259.63 246.65 283.65 11005 745.35 708.08 814.29 0081T 25.96 24.66 28.36 11006 699.08 664.13 763.75 0144T 321.60 305.52 351.35 11008 268.15 254.74 292.95 C 0144T TC 125.46 119.19 137.07 11010 498.48 473.56 544.59 0144T 26 60.30 57.29 65.88 # 11010 281.94 267.84 308.02 0145T 477.38 453.51 521.54 11011 563.85 535.66 616.01 C 0145T TC 371.92 353.32 406.32 # 11011 294.66 279.93 321.92 0145T 26 75.38 71.61 82.35 11012 786.36 747.04 859.10 0146T 633.15 601.49 691.71 # 11012 434.24 412.53 474.41 C 0146T TC 371.92 353.32 406.32 11040 48.35 45.93 52.82 0146T 26 100.50 95.48 109.80 # 11040 27.49 26.12 30.04 0147T 633.15 601.49 691.71 11041 57.18 54.32 62.47 C 0147T TC 371.92 353.32 406.32 # 11041 35.82 34.03 39.13 0147T 26 100.50 95.48 109.80 11042 77.90 74.01 85.11 0148T 633.15 601.49 691.71 # 11042 47.10 44.75 51.46 C 0148T TC 371.92 353.32 406.32 11043 282.91 268.76 309.07 0148T 26 100.50 95.48 109.80 # 11043 241.19 229.13 263.50 0149T 633.15 601.49 691.71 11044 382.27 363.16 417.63 C 0149T TC 371.92 353.32 406.32 # 11044 333.60 316.92 364.46 0149T 26 100.50 95.48 109.80 11055 49.76 47.27 54.36 0150T 633.15 601.49 691.71 # 11055 22.94 21.79 25.06 C 0150T TC 371.92 353.32 406.32 11056 60.44 57.42 66.03 0150T 26 100.50 95.48 109.80 # 11056 32.13 30.52 35.10 0151T 201.00 190.95 219.59 11057 72.32 68.70 79.01 C 0151T TC 125.46 119.19 137.07 # 11057 42.02 39.92 45.91 0151T 26 60.30 57.29 65.88 11100 106.05 100.75 115.86 0159T 21.88 20.79 23.91 # 11100 47.45 45.08 51.84 0159T TC 18.64 17.71 20.37 11101 32.96 31.31 36.01 0159T 26 3.24 3.08 3.54 # 11101 24.02 22.82 26.24 0171T 823.67 782.49 899.86 11200 84.50 80.28 92.32 0172T 411.84 391.25 449.94 # 11200 69.60 66.12 76.04 0177T 1,442.74 1,370.60 1,576.19 11201 18.59 17.66 20.31 10021 153.92 146.22 168.15 # 11201 16.61 15.78 18.15 # 10021 68.99 65.54 75.37 11300 72.47 68.85 79.18 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 3 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11300 28.76 27.32 31.42 11451 483.96 459.76 528.72 11301 95.41 90.64 104.24 # 11451 297.22 282.36 324.71 # 11301 49.22 46.76 53.77 11462 366.99 348.64 400.94 11302 113.24 107.58 123.72 # 11462 218.98 208.03 239.23 # 11302 60.59 57.56 66.19 11463 493.60 468.92 539.26 11303 134.25 127.54 146.67 # 11463 301.40 286.33 329.28 # 11303 71.17 67.61 77.75 11470 396.70 376.87 433.40 11305 72.34 68.72 79.03 # 11470 256.64 243.81 280.38 # 11305 36.58 34.75 39.96 11471 507.09 481.74 554.00 11306 98.27 93.36 107.36 # 11471 322.33 306.21 352.14 # 11306 55.55 52.77 60.69 11600 190.38 180.86 207.99 11307 114.81 109.07 125.43 # 11600 108.93 103.48 119.00 # 11307 64.65 61.42 70.63 11601 225.02 213.77 245.84 11308 129.95 123.45 141.97 # 11601 140.09 133.09 153.05 # 11308 78.30 74.39 85.55 11602 245.12 232.86 267.79 11310 88.10 83.70 96.26 # 11602 152.25 144.64 166.34 # 11310 41.91 39.81 45.78 11603 276.16 262.35 301.70 11311 108.27 102.86 118.29 # 11603 178.82 169.88 195.36 # 11311 61.09 58.04 66.75 11604 304.08 288.88 332.21 11312 125.91 119.61 137.55 # 11604 194.82 185.08 212.84 # 11312 70.28 66.77 76.79 11606 417.23 396.37 455.83 11313 157.68 149.80 172.27 # 11606 284.13 269.92 310.41 # 11313 94.11 89.40 102.81 11620 192.06 182.46 209.83 11400 127.90 121.51 139.74 # 11620 110.11 104.60 120.29 # 11400 76.74 72.90 83.84 11621 226.90 215.56 247.89 11401 150.65 143.12 164.59 # 11621 141.97 134.87 155.10 # 11401 99.49 94.52 108.70 11622 255.12 242.36 278.71 11402 166.60 158.27 182.01 # 11622 162.74 154.60 177.79 # 11402 108.50 103.08 118.54 11623 295.26 280.50 322.58 11403 189.25 179.79 206.76 # 11623 197.92 188.02 216.22 # 11403 137.60 130.72 150.33 11624 332.29 315.68 363.03 11404 214.42 203.70 234.26 # 11624 225.02 213.77 245.84 # 11404 151.34 143.77 165.34 11626 405.88 385.59 443.43 11406 290.93 276.38 317.84 # 11626 284.70 270.47 311.04 # 11406 219.90 208.91 240.25 11640 200.60 190.57 219.16 11420 125.89 119.60 137.54 # 11640 118.16 112.25 129.09 # 11420 82.68 78.55 90.33 11641 242.29 230.18 264.71 11421 158.95 151.00 173.65 # 11641 154.88 147.14 169.21 # 11421 109.28 103.82 119.39 11642 277.63 263.75 303.31 11422 177.08 168.23 193.46 # 11642 181.28 172.22 198.05 # 11422 131.39 124.82 143.54 11643 322.91 306.76 352.77 11423 205.19 194.93 224.17 # 11643 223.58 212.40 244.26 # 11423 151.55 143.97 165.57 11644 398.77 378.83 435.65 11424 233.69 222.01 255.31 # 11644 278.58 264.65 304.35 # 11424 174.09 165.39 190.20 11646 517.40 491.53 565.26 11426 324.98 308.73 355.04 # 11646 391.74 372.15 427.97 # 11426 258.93 245.98 282.88 11719 21.71 20.62 23.71 11440 141.37 134.30 154.45 # 11719 9.29 8.83 10.15 # 11440 102.14 97.03 111.58 11720 31.71 30.12 34.64 11441 171.84 163.25 187.74 # 11720 16.81 15.97 18.37 # 11441 130.12 123.61 142.15 11721 44.67 42.44 48.81 11442 192.15 182.54 209.92 # 11721 28.77 27.33 31.43 # 11442 143.48 136.31 156.76 11730 99.66 94.68 108.88 11443 228.46 217.04 249.60 # 11730 58.93 55.98 64.38 # 11443 175.32 166.55 191.53 11732 45.45 43.18 49.66 11444 284.46 270.24 310.78 # 11732 30.06 28.56 32.84 # 11444 221.88 210.79 242.41 11740 47.09 44.74 51.45 11446 375.52 356.74 410.25 # 11740 33.18 31.52 36.25 # 11446 308.97 293.52 337.55 11750 214.72 203.98 234.58 11450 368.32 349.90 402.39 # 11750 177.97 169.07 194.43 # 11450 226.27 214.96 247.20 11752 302.96 287.81 330.98 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 4 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11752 270.68 257.15 295.72 12013 181.15 172.09 197.90 11755 137.54 130.66 150.26 # 12013 118.57 112.64 129.54 # 11755 85.89 81.60 93.84 12014 211.23 200.67 230.77 11760 209.30 198.84 228.67 # 12014 141.20 134.14 154.26 # 11760 139.77 132.78 152.70 12015 264.37 251.15 288.82 11762 271.55 257.97 296.67 # 12015 175.97 167.17 192.25 # 11762 207.98 197.58 227.22 12016 311.07 295.52 339.85 11765 137.19 130.33 149.88 # 12016 213.73 203.04 233.50 # 11765 70.15 66.64 76.64 12017 258.33 245.41 282.22 11770 270.43 256.91 295.45 12018 309.03 293.58 337.62 # 11770 173.09 164.44 189.11 12020 284.22 270.01 310.51 11771 527.57 501.19 576.37 # 12020 188.86 179.42 206.33 # 11771 396.45 376.63 433.12 12021 160.86 152.82 175.74 11772 654.90 622.16 715.48 # 12021 137.52 130.64 150.24 # 11772 532.72 506.08 581.99 12031 232.15 220.54 253.62 11900 57.26 54.40 62.56 # 12031 146.73 139.39 160.30 # 11900 29.95 28.45 32.72 12032 314.49 298.77 343.59 11901 69.40 65.93 75.82 # 12032 190.82 181.28 208.47 # 11901 46.55 44.22 50.85 12034 300.79 285.75 328.61 11920 210.80 200.26 230.30 # 12034 192.52 182.89 210.32 # 11920 114.95 109.20 125.58 12035 388.02 368.62 423.91 11921 237.25 225.39 259.20 # 12035 233.06 221.41 254.62 # 11921 135.44 128.67 147.97 12036 424.36 403.14 463.61 11922 69.52 66.04 75.95 # 12036 270.89 257.35 295.95 # 11922 30.28 28.77 33.09 12037 475.68 451.90 519.69 11950 80.53 76.50 87.98 # 12037 314.77 299.03 343.88 # 11950 48.74 46.30 53.25 12041 246.00 233.70 268.76 11951 103.19 98.03 112.73 # 12041 158.59 150.66 173.26 # 11951 64.95 61.70 70.96 12042 291.86 277.27 318.86 11952 148.36 140.94 162.08 # 12042 188.06 178.66 205.46 # 11952 97.70 92.82 106.74 12044 329.04 312.59 359.48 11954 174.58 165.85 190.73 # 12044 202.89 192.75 221.66 # 11954 110.51 104.98 120.73 12045 390.55 371.02 426.67 11960 929.69 883.21 1,015.69 # 12045 242.54 230.41 264.97 11970 599.36 569.39 654.80 12046 460.65 437.62 503.26 11971 528.21 501.80 577.07 # 12046 283.84 269.65 310.10 # 11971 312.16 296.55 341.03 12047 492.14 467.53 537.66 11976 151.53 143.95 165.54 # 12047 315.82 300.03 345.03 # 11976 94.91 90.16 103.68 12051 273.59 259.91 298.90 11980 107.48 102.11 117.43 # 12051 174.26 165.55 190.38 # 11980 79.17 75.21 86.49 12052 301.39 286.32 329.27 11981 143.04 135.89 156.27 # 12052 200.07 190.07 218.58 # 11981 84.93 80.68 92.78 12053 328.33 311.91 358.70 11982 163.63 155.45 178.77 # 12053 204.66 194.43 223.59 # 11982 103.04 97.89 112.57 12054 350.12 332.61 382.50 11983 241.47 229.40 263.81 # 12054 218.01 207.11 238.18 # 11983 188.32 178.90 205.74 12055 423.90 402.71 463.12 12001 154.90 147.16 169.23 # 12055 267.95 254.55 292.73 # 12001 99.77 94.78 109.00 12056 524.74 498.50 573.28 12002 164.20 155.99 179.39 # 12056 334.02 317.32 364.92 # 12002 112.05 106.45 122.42 12057 563.73 535.54 615.87 12004 191.91 182.31 209.66 # 12057 384.44 365.22 420.00 # 12004 130.82 124.28 142.92 13100 324.97 308.72 355.03 12005 238.14 226.23 260.16 # 13100 233.09 221.44 254.66 # 12005 161.65 153.57 176.61 13101 404.79 384.55 442.23 12006 295.15 280.39 322.45 # 13101 282.11 268.00 308.20 # 12006 204.26 194.05 223.16 13102 108.15 102.74 118.15 12007 330.82 314.28 361.42 # 13102 72.89 69.25 79.64 # 12007 233.97 222.27 255.61 13120 336.83 319.99 367.99 12011 165.41 157.14 180.71 # 13120 242.47 230.35 264.90 # 12011 103.33 98.16 112.88 13121 443.39 421.22 484.40 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 5 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 13121 316.24 300.43 345.49 15120 951.98 904.38 1,040.04 13122 124.59 118.36 136.11 # 15120 782.12 743.01 854.46 # 13122 82.87 78.73 90.54 15121 297.05 282.20 324.53 13131 370.16 351.65 404.40 # 15121 177.86 168.97 194.32 # 13131 275.30 261.54 300.77 15130 719.45 683.48 786.00 13132 574.08 545.38 627.19 # 15130 572.94 544.29 625.93 # 13132 457.87 434.98 500.23 15131 98.98 94.03 108.13 13133 167.58 159.20 183.08 # 15131 84.08 79.88 91.86 # 13133 129.34 122.87 141.30 15135 884.29 840.08 966.09 13150 377.65 358.77 412.59 # 15135 780.48 741.46 852.68 # 13150 275.33 261.56 300.79 15136 94.30 89.59 103.03 13151 417.36 396.49 455.96 # 15136 85.36 81.09 93.25 # 13151 319.02 303.07 348.53 15150 730.67 694.14 798.26 13152 565.13 536.87 617.40 # 15150 648.73 616.29 708.73 # 13152 425.57 404.29 464.93 15151 129.15 122.69 141.09 13153 186.43 177.11 203.68 # 15151 112.76 107.12 123.19 # 13153 141.23 134.17 154.30 15152 158.34 150.42 172.98 13160 794.26 754.55 867.73 # 15152 140.95 133.90 153.99 14000 665.90 632.61 727.50 15155 754.34 716.62 824.11 # 14000 534.78 508.04 584.25 # 15155 699.70 664.72 764.43 14001 857.07 814.22 936.35 15156 169.69 161.21 185.39 # 14001 711.05 675.50 776.83 # 15156 156.78 148.94 171.28 14020 741.75 704.66 810.36 15157 189.39 179.92 206.91 # 14020 612.12 581.51 668.74 # 15157 171.02 162.47 186.84 14021 962.16 914.05 1,051.16 15170 413.44 392.77 451.69 # 14021 825.08 783.83 901.40 # 15170 341.92 324.82 373.54 14040 777.06 738.21 848.94 15171 89.22 84.76 97.47 # 14040 657.87 624.98 718.73 # 15171 84.25 80.04 92.05 14041 1,054.83 1,002.09 1,152.40 15175 539.80 512.81 589.73 # 14041 901.86 856.77 985.29 # 15175 471.26 447.70 514.86 14060 787.43 748.06 860.27 15176 144.12 136.91 157.45 # 14060 691.57 656.99 755.54 # 15176 135.18 128.42 147.68 14061 1,146.22 1,088.91 1,252.25 15200 810.85 770.31 885.86 # 14061 978.35 929.43 1,068.84 # 15200 642.99 610.84 702.47 14300 1,095.99 1,041.19 1,197.37 15201 163.29 155.13 178.40 # 14300 946.00 898.70 1,033.51 # 15201 76.37 72.55 83.43 14350 751.27 713.71 820.77 15220 781.00 741.95 853.24 15002 345.99 328.69 377.99 # 15220 625.05 593.80 682.87 # 15002 220.34 209.32 240.72 15221 151.89 144.30 165.95 15003 74.51 70.78 81.40 # 15221 70.93 67.38 77.49 # 15003 42.72 40.58 46.67 15240 923.10 876.95 1,008.49 15004 413.71 393.02 451.97 # 15240 789.50 750.03 862.53 # 15004 271.67 258.09 296.80 15241 192.94 183.29 210.78 15005 121.60 115.52 132.85 # 15241 111.99 106.39 122.35 # 15005 86.33 82.01 94.31 15260 986.17 936.86 1,077.39 15040 285.28 271.02 311.67 # 15260 854.06 811.36 933.06 # 15040 128.34 121.92 140.21 15261 222.52 211.39 243.10 15050 558.96 531.01 610.66 # 15261 145.04 137.79 158.46 # 15050 449.20 426.74 490.75 15300 335.95 319.15 367.02 15100 919.24 873.28 1,004.27 # 15300 279.82 265.83 305.70 # 15100 724.05 687.85 791.03 15301 60.35 57.33 65.93 15101 218.32 207.40 238.51 # 15301 55.39 52.62 60.51 # 15101 114.52 108.79 125.11 15320 381.46 362.39 416.75 15110 886.22 841.91 968.20 # 15320 319.38 303.41 348.92 # 15110 735.74 698.95 803.79 15321 90.53 86.00 98.90 15111 123.13 116.97 134.52 # 15321 83.58 79.40 91.31 # 15111 104.26 99.05 113.91 15330 314.10 298.40 343.16 15115 869.76 826.27 950.21 # 15330 256.49 243.67 280.22 # 15115 761.49 723.42 831.93 15331 60.85 57.81 66.48 15116 162.40 154.28 177.42 # 15331 56.38 53.56 61.59 # 15116 142.53 135.40 155.71 15335 336.02 319.22 367.10 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 6 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 15335 277.91 264.01 303.61 15770 655.01 622.26 715.60 15336 88.96 84.51 97.19 15775 324.45 308.23 354.46 # 15336 80.52 76.49 87.96 # 15775 210.22 199.71 229.67 15340 329.42 312.95 359.89 15776 460.25 437.24 502.83 # 15340 272.81 259.17 298.05 # 15776 329.13 312.67 359.57 15341 49.34 46.87 53.90 15780 873.82 830.13 954.65 # 15341 26.99 25.64 29.49 # 15780 675.65 641.87 738.15 15360 376.46 357.64 411.29 15781 564.45 536.23 616.66 # 15360 309.42 293.95 338.04 # 15781 450.71 428.17 492.40 15361 69.45 65.98 75.88 15782 619.55 588.57 676.86 # 15361 62.00 58.90 67.74 # 15782 444.23 422.02 485.32 15365 373.01 354.36 407.51 15783 523.28 497.12 571.69 # 15365 311.93 296.33 340.78 # 15783 383.22 364.06 418.67 15366 87.65 83.27 95.76 15786 253.81 241.12 277.29 # 15366 80.20 76.19 87.62 # 15786 137.09 130.24 149.78 15400 385.09 365.84 420.72 15787 59.91 56.91 65.45 # 15400 354.79 337.05 387.61 # 15787 18.20 17.29 19.88 15401 109.52 104.04 119.65 15788 476.50 452.68 520.58 # 15401 56.88 54.04 62.15 # 15788 253.50 240.83 276.95 15420 434.12 412.41 474.27 15789 609.27 578.81 665.63 # 15420 378.00 359.10 412.97 # 15789 438.43 416.51 478.99 15421 117.85 111.96 128.75 15792 466.55 443.22 509.70 # 15421 83.58 79.40 91.31 # 15792 291.72 277.13 318.70 15430 554.76 527.02 606.07 15793 493.79 469.10 539.47 # 15430 533.90 507.21 583.29 # 15793 366.64 348.31 400.56 15570 905.68 860.40 989.46 15819 726.26 689.95 793.44 # 15570 698.08 663.18 762.66 15820 551.00 523.45 601.97 15572 847.82 805.43 926.24 # 15820 486.44 462.12 531.44 # 15572 694.85 660.11 759.13 15821 585.62 556.34 639.79 15574 916.58 870.75 1,001.36 # 15821 513.11 487.45 560.57 # 15574 757.65 719.77 827.74 15822 438.54 416.61 479.10 15576 821.04 779.99 896.99 # 15822 376.95 358.10 411.82 # 15576 671.06 637.51 733.14 15823 670.22 636.71 732.22 15600 394.08 374.38 430.54 # 15823 603.17 573.01 658.96 # 15600 217.77 206.88 237.91 15830 1,133.42 1,076.75 1,238.26 15610 347.37 330.00 379.50 15832 885.26 841.00 967.15 # 15610 253.51 240.83 276.95 15833 826.37 785.05 902.81 15620 486.87 462.53 531.91 15834 841.74 799.65 919.60 # 15620 325.96 309.66 356.11 15835 858.47 815.55 937.88 15630 494.62 469.89 540.37 15836 726.66 690.33 793.88 # 15630 354.06 336.36 386.81 15837 777.06 738.21 848.94 15650 527.72 501.33 576.53 # 15837 675.74 641.95 738.24 # 15650 383.19 364.03 418.63 15838 577.90 549.01 631.36 15731 1,106.62 1,051.29 1,208.98 15839 844.73 802.49 922.86 # 15731 979.47 930.50 1,070.08 # 15839 702.19 667.08 767.14 15732 1,536.56 1,459.73 1,678.69 15840 1,008.20 957.79 1,101.46 # 15732 1,303.13 1,237.97 1,423.67 15841 1,651.51 1,568.93 1,804.27 15734 1,573.75 1,495.06 1,719.32 15842 2,599.49 2,469.52 2,839.95 # 15734 1,335.85 1,269.06 1,459.42 15845 942.31 895.19 1,029.47 15736 1,422.62 1,351.49 1,554.21 15851 106.15 100.84 115.97 # 15736 1,153.93 1,096.23 1,260.66 # 15851 44.56 42.33 48.68 15738 1,498.99 1,424.04 1,637.65 15852 46.17 43.86 50.44 # 15738 1,254.64 1,191.91 1,370.70 15860 108.50 103.08 118.54 15740 1,003.17 953.01 1,095.96 15920 574.63 545.90 627.79 # 15740 853.18 810.52 932.10 15922 740.86 703.82 809.39 15750 914.91 869.16 999.53 15931 650.47 617.95 710.64 15756 2,340.10 2,223.10 2,556.57 15933 809.53 769.05 884.41 15757 2,341.35 2,224.28 2,557.92 15934 897.27 852.41 980.27 15758 2,331.67 2,215.09 2,547.35 15935 1,067.35 1,013.98 1,166.08 15760 860.93 817.88 940.56 15936 876.56 832.73 957.64 # 15760 708.46 673.04 774.00 15937 1,028.28 976.87 1,123.40 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 7 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 15940 674.69 640.96 737.10 17276 284.96 270.71 311.32 15941 902.37 857.25 985.84 # 17276 205.50 195.23 224.51 15944 874.65 830.92 955.56 17280 141.20 134.14 154.26 15945 966.72 918.38 1,056.14 # 17280 88.06 83.66 96.21 15946 1,587.34 1,507.97 1,734.17 17281 176.90 168.06 193.27 15950 564.37 536.15 616.57 # 17281 121.78 115.69 133.04 15951 803.61 763.43 877.94 17282 204.52 194.29 223.43 15952 831.55 789.97 908.47 # 17282 140.46 133.44 153.46 15953 929.11 882.65 1,015.05 17283 245.87 233.58 268.62 15956 1,125.21 1,068.95 1,229.29 # 17283 175.35 166.58 191.57 15958 1,153.25 1,095.59 1,259.93 17284 285.84 271.55 312.28 16000 71.58 68.00 78.20 # 17284 208.36 197.94 227.63 # 16000 44.76 42.52 48.90 17286 360.71 342.67 394.07 16020 88.80 84.36 97.01 # 17286 281.74 267.65 307.80 # 16020 57.51 54.63 62.82 17311 751.83 714.24 821.38 16025 151.01 143.46 164.98 # 17311 371.40 352.83 405.75 # 16025 113.26 107.60 123.74 17312 459.45 436.48 501.95 16030 182.75 173.61 199.65 # 17312 197.71 187.82 215.99 # 16030 130.10 123.60 142.14 17313 688.15 653.74 751.80 16035 208.47 198.05 227.76 # 17313 333.54 316.86 364.39 16036 82.38 78.26 90.00 17314 424.75 403.51 464.04 17000 81.37 77.30 88.90 # 17314 182.88 173.74 199.80 # 17000 54.06 51.36 59.06 17315 87.55 83.17 95.65 17003 8.03 7.63 8.77 # 17315 52.29 49.68 57.13 # 17003 5.05 4.80 5.52 17340 45.28 43.02 49.47 17004 182.96 173.81 199.88 # 17340 45.78 43.49 50.01 # 17004 138.76 131.82 151.59 17360 133.19 126.53 145.51 17106 398.36 378.44 435.21 # 17360 97.92 93.02 106.97 # 17106 331.81 315.22 362.50 19000 127.62 121.24 139.43 17107 683.57 649.39 746.80 # 19000 45.18 42.92 49.36 # 17107 589.70 560.22 644.25 19001 27.80 26.41 30.37 17108 919.87 873.88 1,004.96 # 19001 22.34 21.22 24.40 # 17108 818.56 777.63 894.27 19020 460.57 437.54 503.17 17110 108.69 103.26 118.75 # 19020 280.78 266.74 306.75 # 17110 63.49 60.32 69.37 19030 192.57 182.94 210.38 17111 131.05 124.50 143.18 # 19030 80.83 76.79 88.31 # 17111 81.38 77.31 88.91 19100 150.67 143.14 164.61 17250 81.63 77.55 89.18 # 19100 65.74 62.45 71.82 # 17250 36.43 34.61 39.80 19101 339.52 322.54 370.92 17260 99.66 94.68 108.88 # 19101 210.89 200.35 230.40 # 17260 67.38 64.01 73.61 19102 253.44 240.77 276.89 17261 144.18 136.97 157.52 # 19102 105.44 100.17 115.20 # 17261 89.55 85.07 97.83 19103 670.49 636.97 732.52 17262 173.96 165.26 190.05 # 19103 194.20 184.49 212.16 # 17262 113.87 108.18 124.41 19105 2,444.04 2,321.84 2,670.12 17263 191.19 181.63 208.87 # 19105 183.77 174.58 200.77 # 17263 125.13 118.87 136.70 19110 456.96 434.11 499.23 17264 206.34 196.02 225.42 # 19110 310.45 294.93 339.17 # 17264 133.33 126.66 145.66 19112 444.40 422.18 485.51 17266 232.74 221.10 254.27 # 19112 283.48 269.31 309.71 # 17266 153.28 145.62 167.46 19120 456.19 433.38 498.39 17270 150.30 142.79 164.21 # 19120 376.72 357.88 411.56 # 17270 96.16 91.35 105.05 19125 501.49 476.42 547.88 17271 163.86 155.67 179.02 # 19125 417.06 396.21 455.64 # 17271 108.23 102.82 118.24 19126 152.56 144.93 166.67 17272 187.32 177.95 204.64 19260 1,182.96 1,123.81 1,292.38 # 17272 125.24 118.98 136.83 19271 1,651.04 1,568.49 1,803.76 17273 207.90 197.51 227.14 19272 1,813.51 1,722.83 1,981.25 # 17273 140.35 133.33 153.33 19290 188.07 178.67 205.47 17274 246.08 233.78 268.85 # 19290 66.89 63.55 73.08 # 17274 171.58 163.00 187.45 19291 80.58 76.55 88.03 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 8 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 19291 32.90 31.26 35.95 # 20225 123.10 116.95 134.49 19295 123.87 117.68 135.33 20240 235.33 223.56 257.09 19296 5,385.48 5,116.21 5,883.64 20245 636.66 604.83 695.55 # 19296 200.90 190.86 219.49 20250 376.88 358.04 411.75 19297 89.75 85.26 98.05 20251 419.40 398.43 458.19 19298 1,810.96 1,720.41 1,978.47 20500 135.16 128.40 147.66 # 19298 328.94 312.49 359.36 # 20500 105.36 100.09 115.10 19300 571.89 543.30 624.80 20501 158.32 150.40 172.96 # 19300 374.71 355.97 409.37 # 20501 40.11 38.10 43.82 19301 562.71 534.57 614.76 20520 206.34 196.02 225.42 19302 827.84 786.45 904.42 # 20520 149.22 141.76 163.02 19303 866.00 822.70 946.11 20525 535.86 509.07 585.43 19304 533.02 506.37 582.33 # 20525 252.27 239.66 275.61 19305 1,036.06 984.26 1,131.90 20526 79.54 75.56 86.89 19306 1,082.63 1,028.50 1,182.78 # 20526 58.18 55.27 63.56 19307 1,087.69 1,033.31 1,188.31 20550 61.10 58.05 66.76 19316 773.32 734.65 844.85 # 20550 40.74 38.70 44.51 19318 1,134.92 1,078.17 1,239.90 20551 60.40 57.38 65.99 19324 480.33 456.31 524.76 # 20551 43.02 40.87 47.00 19325 643.80 611.61 703.35 20552 56.14 53.33 61.33 19328 487.51 463.13 532.60 # 20552 34.79 33.05 38.01 19330 614.70 583.97 671.57 20553 63.06 59.91 68.90 19340 387.97 368.57 423.86 # 20553 38.73 36.79 42.31 19342 911.06 865.51 995.34 20555 324.97 308.72 355.03 19350 930.16 883.65 1,016.20 20600 57.25 54.39 62.55 # 19350 682.33 648.21 745.44 # 20600 40.86 38.82 44.64 19355 747.54 710.16 816.68 20605 62.51 59.38 68.29 # 19355 541.92 514.82 592.04 # 20605 42.15 40.04 46.05 19357 1,543.43 1,466.26 1,686.20 20610 79.97 75.97 87.37 19361 1,589.20 1,509.74 1,736.20 # 20610 50.17 47.66 54.81 19364 2,733.52 2,596.84 2,986.37 20612 61.22 58.16 66.88 19366 1,352.72 1,285.08 1,477.84 # 20612 43.34 41.17 47.35 19367 1,796.81 1,706.97 1,963.02 20615 238.48 226.56 260.54 19368 2,196.41 2,086.59 2,399.58 # 20615 164.98 156.73 180.24 19369 2,030.50 1,928.98 2,218.33 20650 203.99 193.79 222.86 19370 678.40 644.48 741.15 # 20650 158.79 150.85 173.48 19371 779.94 740.94 852.08 20660 263.88 250.69 288.29 19380 763.82 725.63 834.47 # 20660 227.63 216.25 248.69 19396 220.89 209.85 241.33 20661 473.80 450.11 517.63 # 19396 137.95 131.05 150.71 20662 485.18 460.92 530.06 20000 215.22 204.46 235.13 20663 454.48 431.76 496.52 # 20000 160.09 152.09 174.90 20664 746.51 709.18 815.56 20005 310.44 294.92 339.16 20665 137.36 130.49 150.06 # 20005 238.43 226.51 260.49 # 20665 107.56 102.18 117.51 20100 582.69 553.56 636.59 20670 517.71 491.82 565.59 20101 431.72 410.13 471.65 # 20670 160.62 152.59 175.48 # 20101 198.79 188.85 217.18 20680 636.86 605.02 695.77 20102 505.12 479.86 551.84 # 20680 409.40 388.93 447.27 # 20102 239.91 227.91 262.10 20690 496.37 471.55 542.28 20103 606.85 576.51 662.99 20692 913.52 867.84 998.02 # 20103 353.06 335.41 385.72 20693 473.96 450.26 517.80 20150 912.56 866.93 996.97 20694 469.60 446.12 513.04 20200 207.47 197.10 226.67 # 20694 347.92 330.52 380.10 # 20200 91.25 86.69 99.69 20802 2,394.10 2,274.40 2,615.56 20205 279.95 265.95 305.84 20805 3,171.44 3,012.87 3,464.80 # 20205 144.86 137.62 158.26 20808 4,119.58 3,913.60 4,500.64 20206 326.73 310.39 356.95 20816 2,538.47 2,411.55 2,773.28 # 20206 65.49 62.22 71.55 20822 2,235.49 2,123.72 2,442.28 20220 226.02 214.72 246.93 20824 2,505.54 2,380.26 2,737.30 # 20220 81.99 77.89 89.57 20827 2,291.98 2,177.38 2,503.99 20225 974.86 926.12 1,065.04 20838 2,400.78 2,280.74 2,622.85 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 9 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 20900 657.76 624.87 718.60 # 21076 870.50 826.98 951.03 # 20900 481.94 457.84 526.52 21077 2,497.95 2,373.05 2,729.01 20902 622.69 591.56 680.29 # 21077 2,201.94 2,091.84 2,405.62 20910 444.29 422.08 485.39 21079 1,719.31 1,633.34 1,878.34 20912 503.27 478.11 549.83 # 21079 1,465.52 1,392.24 1,601.08 20920 413.87 393.18 452.16 21080 1,955.27 1,857.51 2,136.14 20922 626.32 595.00 684.25 # 21080 1,650.82 1,568.28 1,803.52 # 20922 496.19 471.38 542.09 21081 1,785.03 1,695.78 1,950.15 20924 519.29 493.33 567.33 # 21081 1,500.94 1,425.89 1,639.77 20926 444.88 422.64 486.04 21082 1,637.00 1,555.15 1,788.42 20931 111.11 105.55 121.38 # 21082 1,382.72 1,313.58 1,510.62 20937 170.46 161.94 186.23 21083 1,564.56 1,486.33 1,709.28 20938 184.85 175.61 201.95 # 21083 1,278.98 1,215.03 1,397.28 20950 322.94 306.79 352.81 21084 1,800.31 1,710.29 1,966.83 # 20950 94.47 89.75 103.21 # 21084 1,486.43 1,412.11 1,623.93 20955 2,551.50 2,423.93 2,787.52 21085 715.74 679.95 781.94 20956 2,682.53 2,548.40 2,930.66 # 21085 593.56 563.88 648.46 20957 2,477.39 2,353.52 2,706.55 21086 1,849.52 1,757.04 2,020.60 20962 2,682.23 2,548.12 2,930.34 # 21086 1,631.49 1,549.92 1,782.41 20969 2,848.07 2,705.67 3,111.52 21087 1,835.58 1,743.80 2,005.37 20970 2,820.25 2,679.24 3,081.13 # 21087 1,622.51 1,541.38 1,772.59 20972 2,522.81 2,396.67 2,756.17 21088 2,795.68 2,655.90 3,054.29 20973 2,718.26 2,582.35 2,969.70 21100 820.83 779.79 896.76 20974 65.12 61.86 71.14 # 21100 420.52 399.49 459.41 # 20974 49.23 46.77 53.79 21110 777.63 738.75 849.56 20975 179.05 170.10 195.62 # 21110 665.39 632.12 726.94 20979 58.76 55.82 64.19 21116 199.04 189.09 217.45 # 20979 36.90 35.06 40.32 # 21116 43.09 40.94 47.08 20982 4,976.87 4,728.03 5,437.23 21120 687.73 653.34 751.34 # 20982 406.66 386.33 444.28 # 21120 536.25 509.44 585.86 20985 145.59 138.31 159.06 21121 791.44 751.87 864.65 21010 732.95 696.30 800.75 # 21121 668.27 634.86 730.09 21015 439.46 417.49 480.11 21122 743.67 706.49 812.46 21025 1,026.72 975.38 1,121.69 21123 860.64 817.61 940.25 # 21025 860.34 817.32 939.92 21125 3,347.84 3,180.45 3,657.52 21026 619.12 588.16 676.38 # 21125 752.82 715.18 822.46 # 21026 508.86 483.42 555.93 21127 3,630.62 3,449.09 3,966.45 21029 775.79 737.00 847.55 # 21127 876.67 832.84 957.77 # 21029 641.70 609.62 701.06 21137 754.75 717.01 824.56 21030 513.33 487.66 560.81 21138 907.23 861.87 991.15 # 21030 418.96 398.01 457.71 21139 989.21 939.75 1,080.71 21031 397.95 378.05 434.76 21141 1,350.13 1,282.62 1,475.01 # 21031 299.12 284.16 326.78 21142 1,310.59 1,245.06 1,431.82 21032 406.48 386.16 444.08 21143 1,401.96 1,331.86 1,531.64 # 21032 294.24 279.53 321.46 21145 1,545.51 1,468.23 1,688.46 21034 1,372.50 1,303.88 1,499.46 21146 1,523.11 1,446.95 1,663.99 # 21034 1,196.69 1,136.86 1,307.39 21147 1,673.36 1,589.69 1,828.14 21040 515.31 489.54 562.97 21150 1,783.00 1,693.85 1,947.93 # 21040 410.02 389.52 447.95 21151 1,906.09 1,810.79 2,082.41 21044 894.04 849.34 976.74 21154 2,146.58 2,039.25 2,345.14 21045 1,235.03 1,173.28 1,349.27 21155 2,393.63 2,273.95 2,615.04 21046 1,103.38 1,048.21 1,205.44 21159 2,753.54 2,615.86 3,008.24 21047 1,318.55 1,252.62 1,440.51 21160 2,972.42 2,823.80 3,247.37 21048 1,122.35 1,066.23 1,226.16 21172 1,728.96 1,642.51 1,888.89 21049 1,273.11 1,209.45 1,390.87 21175 2,036.28 1,934.47 2,224.64 21050 868.62 825.19 948.97 21179 1,468.35 1,394.93 1,604.17 21060 798.94 758.99 872.84 21180 1,658.81 1,575.87 1,812.25 21070 653.11 620.45 713.52 21181 734.87 698.13 802.85 21073 397.31 377.44 434.06 21182 2,037.04 1,935.19 2,225.47 # 21073 238.88 226.94 260.98 21183 2,319.53 2,203.55 2,534.08 21076 1,011.55 960.97 1,105.12 21184 2,384.42 2,265.20 2,604.98 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 10 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21188 1,689.06 1,604.61 1,845.30 21344 1,525.05 1,448.80 1,666.12 21193 1,250.53 1,188.00 1,366.20 21345 831.42 789.85 908.33 21194 1,431.61 1,360.03 1,564.03 # 21345 667.52 634.14 729.26 21195 1,381.17 1,312.11 1,508.93 21346 988.26 938.85 1,079.68 21196 1,491.74 1,417.15 1,629.72 21347 1,187.31 1,127.94 1,297.13 21198 1,177.00 1,118.15 1,285.87 21348 1,202.19 1,142.08 1,313.39 21199 1,019.58 968.60 1,113.89 21355 458.05 435.15 500.42 21206 1,144.50 1,087.28 1,250.37 # 21355 323.95 307.75 353.91 21208 1,787.65 1,698.27 1,953.01 21356 522.56 496.43 570.89 # 21208 846.00 803.70 924.26 # 21356 385.98 366.68 421.68 21209 852.17 809.56 930.99 21360 540.46 513.44 590.46 # 21209 664.93 631.68 726.43 21365 1,102.81 1,047.67 1,204.82 21210 2,119.95 2,013.95 2,316.04 21366 1,232.85 1,171.21 1,346.89 # 21210 844.04 801.84 922.12 21385 730.74 694.20 798.33 21215 3,624.66 3,443.43 3,959.94 21386 672.63 639.00 734.85 # 21215 875.68 831.90 956.69 21387 776.72 737.88 848.56 21230 783.85 744.66 856.36 21390 770.33 731.81 841.58 21235 761.71 723.62 832.16 21395 967.78 919.39 1,057.30 # 21235 578.94 549.99 632.49 21400 185.18 175.92 202.31 21240 1,126.77 1,070.43 1,230.99 # 21400 148.43 141.01 162.16 21242 1,043.14 990.98 1,139.63 21401 504.89 479.65 551.60 21243 1,684.46 1,600.24 1,840.28 # 21401 293.81 279.12 320.99 21244 1,075.15 1,021.39 1,174.60 21406 551.09 523.54 602.07 21245 1,181.55 1,122.47 1,290.84 21407 645.66 613.38 705.39 # 21245 929.75 883.26 1,015.75 21408 874.61 830.88 955.51 21246 879.80 835.81 961.18 21421 757.47 719.60 827.54 21247 1,638.45 1,556.53 1,790.01 # 21421 651.19 618.63 711.42 21248 1,081.22 1,027.16 1,181.23 21422 694.55 659.82 758.79 # 21248 886.53 842.20 968.53 21423 812.95 772.30 888.15 21249 1,501.20 1,426.14 1,640.06 21431 788.94 749.49 861.91 # 21249 1,248.90 1,186.46 1,364.43 21432 689.65 655.17 753.45 21255 1,427.58 1,356.20 1,559.63 21433 1,672.25 1,588.64 1,826.94 21256 1,166.10 1,107.80 1,273.97 21435 1,325.87 1,259.58 1,448.52 21260 1,274.11 1,210.40 1,391.96 21436 1,883.28 1,789.12 2,057.49 21261 2,209.98 2,099.48 2,414.40 21440 548.18 520.77 598.89 21263 1,941.83 1,844.74 2,121.45 # 21440 459.78 436.79 502.31 21267 1,634.12 1,552.41 1,785.27 21445 772.72 734.08 844.19 21268 1,831.62 1,740.04 2,001.05 # 21445 643.59 611.41 703.12 21270 946.03 898.73 1,033.54 21450 574.50 545.78 627.65 # 21270 706.15 670.84 771.47 # 21450 492.55 467.92 538.11 21275 810.78 770.24 885.78 21451 757.03 719.18 827.06 21280 535.96 509.16 585.53 # 21451 651.24 618.68 711.48 21282 362.42 344.30 395.95 21452 707.86 672.47 773.34 21295 184.48 175.26 201.55 # 21452 350.27 332.76 382.67 21296 425.56 404.28 464.92 21453 871.92 828.32 952.57 21310 127.39 121.02 139.17 # 21453 793.45 753.78 866.85 # 21310 27.56 26.18 30.11 21454 563.20 535.04 615.30 21315 287.18 272.82 313.74 21461 1,978.56 1,879.63 2,161.57 # 21315 155.57 147.79 169.96 # 21461 967.37 919.00 1,056.85 21320 272.38 258.76 297.57 21462 2,153.40 2,045.73 2,352.59 # 21320 142.26 135.15 155.42 # 21462 1,048.35 995.93 1,145.32 21325 534.69 507.96 584.15 21465 922.66 876.53 1,008.01 21330 638.92 606.97 698.02 21470 1,189.25 1,129.79 1,299.26 21335 773.70 735.02 845.27 21480 104.44 99.22 114.10 21336 692.78 658.14 756.86 # 21480 31.43 29.86 34.34 21337 423.68 402.50 462.88 21485 673.70 640.02 736.02 # 21337 296.04 281.24 323.43 # 21485 585.79 556.50 639.98 21338 846.02 803.72 924.28 21490 923.35 877.18 1,008.76 21339 900.12 855.11 983.38 21495 705.95 670.65 771.25 21340 805.35 765.08 879.84 21497 678.11 644.20 740.83 21343 1,221.74 1,160.65 1,334.75 # 21497 586.72 557.38 640.99 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 11 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21501 465.38 442.11 508.43 22310 282.21 268.10 308.32 # 21501 325.33 309.06 355.42 # 22310 258.87 245.93 282.82 21502 530.62 504.09 579.70 22315 867.93 824.53 948.21 21510 486.85 462.51 531.89 # 22315 748.73 711.29 817.98 21550 272.50 258.88 297.71 22318 1,551.77 1,474.18 1,695.31 # 21550 162.24 154.13 177.25 22319 1,695.37 1,610.60 1,852.19 21555 444.43 422.21 485.54 22325 1,361.53 1,293.45 1,487.47 # 21555 328.21 311.80 358.57 22326 1,420.59 1,349.56 1,551.99 21556 413.20 392.54 451.42 22327 1,406.80 1,336.46 1,536.93 21557 576.50 547.68 629.83 22328 278.48 264.56 304.24 21600 558.43 530.51 610.09 22505 122.97 116.82 134.34 21610 1,050.91 998.36 1,148.11 22520 2,974.10 2,825.40 3,249.21 21615 681.65 647.57 744.71 # 22520 593.63 563.95 648.54 21616 833.95 792.25 911.09 22521 2,839.33 2,697.36 3,101.96 21620 535.17 508.41 584.67 # 22521 561.67 533.59 613.63 21627 564.19 535.98 616.38 22522 244.93 232.68 267.58 21630 1,263.32 1,200.15 1,380.17 22523 617.17 586.31 674.26 21632 1,240.85 1,178.81 1,355.63 22524 592.00 562.40 646.76 21685 1,003.26 953.10 1,096.07 22525 270.21 256.70 295.21 21700 442.25 420.14 483.16 22526 2,555.20 2,427.44 2,791.56 21705 617.02 586.17 674.10 # 22526 336.14 319.33 367.23 21720 380.43 361.41 415.62 22527 2,123.45 2,017.28 2,319.87 21725 534.02 507.32 583.42 # 22527 151.73 144.14 165.76 21740 1,069.19 1,015.73 1,168.09 22532 1,694.50 1,609.78 1,851.25 21750 710.73 675.19 776.47 22533 1,592.75 1,513.11 1,740.08 21800 102.75 97.61 112.25 22534 365.12 346.86 398.89 # 21800 104.24 99.03 113.88 22548 1,809.55 1,719.07 1,976.93 21805 265.93 252.63 290.52 22554 1,270.48 1,206.96 1,388.00 21810 515.76 489.97 563.47 22556 1,625.97 1,544.67 1,776.37 21820 139.44 132.47 152.34 22558 1,487.66 1,413.28 1,625.27 21825 580.58 551.55 634.28 22585 337.55 320.67 368.77 21920 266.63 253.30 291.30 22590 1,501.55 1,426.47 1,640.44 # 21920 158.36 150.44 173.01 22595 1,431.97 1,360.37 1,564.43 21925 430.99 409.44 470.86 22600 1,228.89 1,167.45 1,342.57 # 21925 333.65 316.97 364.52 22610 1,216.51 1,155.68 1,329.03 21930 481.12 457.06 525.62 22612 1,565.49 1,487.22 1,710.30 # 21930 367.39 349.02 401.37 22614 395.05 375.30 431.60 21935 1,137.10 1,080.25 1,242.29 22630 1,505.29 1,430.03 1,644.53 22010 899.53 854.55 982.73 22632 320.51 304.48 350.15 22015 893.69 849.01 976.36 22800 1,340.60 1,273.57 1,464.61 22100 809.00 768.55 883.83 22802 2,116.40 2,010.58 2,312.17 22101 810.54 770.01 885.51 22804 2,450.50 2,327.98 2,677.18 22102 813.90 773.21 889.19 22808 1,802.01 1,711.91 1,968.70 22103 142.24 135.13 155.40 22810 2,016.74 1,915.90 2,203.29 22110 989.37 939.90 1,080.89 22812 2,217.33 2,106.46 2,422.43 22112 987.34 937.97 1,078.67 22818 2,198.79 2,088.85 2,402.18 22114 988.59 939.16 1,080.03 22819 2,481.95 2,357.85 2,711.53 22116 141.68 134.60 154.79 22830 805.80 765.51 880.34 22206 2,290.58 2,176.05 2,502.46 22840 771.35 732.78 842.70 22207 2,264.03 2,150.83 2,473.45 22842 772.21 733.60 843.64 22208 562.57 534.44 614.61 22843 816.59 775.76 892.12 22210 1,727.26 1,640.90 1,887.04 22844 1,010.93 960.38 1,104.44 22212 1,437.98 1,366.08 1,570.99 22845 734.41 697.69 802.34 22214 1,454.76 1,382.02 1,589.32 22846 763.53 725.35 834.15 22216 370.99 352.44 405.31 22847 842.29 800.18 920.21 22220 1,560.85 1,482.81 1,705.23 22848 368.05 349.65 402.10 22222 1,412.51 1,341.88 1,543.16 22849 1,284.92 1,220.67 1,403.77 22224 1,551.31 1,473.74 1,694.80 22850 712.43 676.81 778.33 22226 369.00 350.55 403.13 22851 409.23 388.77 447.09 22305 190.77 181.23 208.41 22852 683.19 649.03 746.38 # 22305 172.39 163.77 188.34 22855 1,087.09 1,032.74 1,187.65 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 12 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 22857 1,742.33 1,655.21 1,903.49 23412 965.58 917.30 1,054.90 22862 2,033.08 1,931.43 2,221.14 23415 747.62 710.24 816.78 22865 1,981.32 1,882.25 2,164.59 23420 1,069.41 1,015.94 1,168.33 22900 396.41 376.59 433.08 23430 753.50 715.83 823.20 23000 574.02 545.32 627.12 23440 775.84 737.05 847.61 # 23000 368.90 350.46 403.03 23450 966.47 918.15 1,055.87 23020 700.60 665.57 765.41 23455 1,027.25 975.89 1,122.27 23030 470.65 447.12 514.19 23460 1,113.30 1,057.64 1,216.29 # 23030 262.56 249.43 286.84 23462 1,086.77 1,032.43 1,187.29 23031 462.17 439.06 504.92 23465 1,130.39 1,073.87 1,234.95 # 23031 227.75 216.36 248.81 23466 1,120.39 1,064.37 1,224.03 23035 708.97 673.52 774.55 23470 1,232.22 1,170.61 1,346.20 23040 729.62 693.14 797.11 23472 1,513.71 1,438.02 1,653.72 23044 581.79 552.70 635.61 23480 835.23 793.47 912.49 23065 218.32 207.40 238.51 23485 975.25 926.49 1,065.46 # 23065 166.67 158.34 182.09 23490 831.32 789.75 908.21 23066 542.36 515.24 592.53 23491 1,032.44 980.82 1,127.94 # 23066 347.67 330.29 379.83 23500 217.23 206.37 237.33 23075 273.19 259.53 298.46 # 23500 210.27 199.76 229.72 # 23075 177.33 168.46 193.73 23505 351.09 333.54 383.57 23076 562.58 534.45 614.62 # 23505 327.25 310.89 357.52 23077 1,167.32 1,108.95 1,275.29 23515 693.23 658.57 757.36 23100 497.00 472.15 542.97 23520 223.28 212.12 243.94 23101 460.24 437.23 502.81 # 23520 222.29 211.18 242.86 23105 647.07 614.72 706.93 23525 352.62 334.99 385.24 23106 489.64 465.16 534.93 # 23525 324.81 308.57 354.86 23107 673.21 639.55 735.48 23530 559.16 531.20 610.88 23120 572.43 543.81 625.38 23532 631.34 599.77 689.74 23125 709.70 674.22 775.35 23540 222.64 211.51 243.24 23130 619.42 588.45 676.72 # 23540 211.71 201.12 231.29 23140 516.80 490.96 564.60 23545 319.30 303.34 348.84 23145 698.28 663.37 762.88 # 23545 286.52 272.19 313.02 23146 627.39 596.02 685.42 23550 581.00 551.95 634.74 23150 659.01 626.06 719.97 23552 668.64 635.21 730.49 23155 795.54 755.76 869.12 23570 230.52 218.99 251.84 23156 682.18 648.07 745.28 # 23570 231.02 219.47 252.39 23170 542.62 515.49 592.81 23575 390.39 370.87 426.50 23172 563.29 535.13 615.40 # 23575 363.57 345.39 397.20 23174 762.93 724.78 833.50 23585 920.62 874.59 1,005.78 23180 719.66 683.68 786.23 23600 327.81 311.42 358.13 23182 693.70 659.02 757.87 # 23600 292.54 277.91 319.60 23184 774.79 736.05 846.46 23605 475.00 451.25 518.94 23190 564.12 535.91 616.30 # 23605 429.31 407.84 469.02 23195 754.12 716.41 823.87 23615 872.89 829.25 953.64 23200 872.78 829.14 953.51 23616 1,317.18 1,251.32 1,439.02 23210 915.49 869.72 1,000.18 23620 267.94 254.54 292.72 23220 1,079.73 1,025.74 1,179.60 # 23620 246.08 233.78 268.85 23221 1,255.50 1,192.73 1,371.64 23625 384.81 365.57 420.41 23222 1,686.27 1,601.96 1,842.25 # 23625 355.51 337.73 388.39 23330 244.69 232.46 267.33 23630 733.88 697.19 801.77 # 23330 154.30 146.59 168.58 23650 300.76 285.72 328.58 23331 600.08 570.08 655.59 # 23650 264.01 250.81 288.43 23332 895.11 850.35 977.90 23655 381.74 362.65 417.05 23350 189.84 180.35 207.40 23660 588.16 558.75 642.56 # 23350 52.76 50.12 57.64 23665 424.79 403.55 464.08 23395 1,292.32 1,227.70 1,411.86 # 23665 394.99 375.24 431.53 23397 1,152.38 1,094.76 1,258.97 23670 814.45 773.73 889.79 23400 985.38 936.11 1,076.53 23675 555.07 527.32 606.42 23405 640.61 608.58 699.87 # 23675 505.91 480.61 552.70 23406 795.32 755.55 868.88 23680 892.16 847.55 974.68 23410 909.27 863.81 993.38 23700 198.50 188.58 216.87 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 31140 PAGE 13 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 23800 1,032.92 981.27 1,128.46 24342 797.35 757.48 871.10 23802 1,216.75 1,155.91 1,329.30 24343 717.01 681.16 783.33 23900 1,328.00 1,261.60 1,450.84 24344 1,100.75 1,045.71 1,202.57 23920 1,082.20 1,028.09 1,182.30 24345 712.74 677.10 778.67 23921 457.28 434.42 499.58 24346 1,097.66 1,042.78 1,199.20 23930 392.16 372.55 428.43 24357 457.81 434.92 500.16 # 23930 218.33 207.41 238.52 24358 533.23 506.57 582.56 23931 323.60 307.42 353.53 24359 643.84 611.65 703.40 # 23931 165.67 157.39 181.00 24360 906.46 861.14 990.31 23935 512.44 486.82 559.84 24361 1,019.92 968.92 1,114.26 24000 479.61 455.63 523.97 24362 971.58 923.00 1,061.45 24006 720.73 684.69 787.39 24363 1,484.07 1,409.87 1,621.35 24065 259.09 246.14 283.06 24365 651.00 618.45 711.22 # 24065 167.21 158.85 182.68 24366 696.12 661.31 760.51 24066 626.26 594.95 684.19 24400 833.50 791.83 910.60 # 24066 398.79 378.85 435.68 24410 1,056.96 1,004.11 1,154.73 24075 509.92 484.42 557.08 24420 988.74 939.30 1,080.20 # 24075 314.24 298.53 343.31 24430 1,039.16 987.20 1,135.28 24076 474.32 450.60 518.19 24435 1,071.67 1,018.09 1,170.80 24077 812.11 771.50 887.23 24470 668.02 634.62 729.81 24100 404.26 384.05 441.66 24495 688.39 653.97 752.07 24101 508.28 482.87 555.30 24498 884.63 840.40 966.46 24102 624.74 593.50 682.53 24500 355.34 337.57 388.21 24105 348.72 331.28 380.97 # 24500 310.64 295.11 339.38 24110 590.76 561.22 645.40 24505 509.00 483.55 556.08 24115 667.76 634.37 729.53 # 24505 455.36 432.59 497.48 24116 877.98 834.08 959.19 24515 889.53 845.05 971.81 24120 530.80 504.26 579.90 24516 876.19 832.38 957.24 24125 601.60 571.52 657.25 24530 382.11 363.00 417.45 24126 642.43 610.31 701.86 # 24530 334.93 318.18 365.91 24130 517.29 491.43 565.14 24535 629.50 598.03 687.73 24134 774.89 736.15 846.57 # 24535 575.37 546.60 628.59 24136 638.43 606.51 697.49 24538 762.22 724.11 832.73 24138 670.98 637.43 733.04 24545 903.52 858.34 987.09 24140 747.02 709.67 816.12 24546 1,074.20 1,020.49 1,173.56 24145 632.69 601.06 691.22 24560 322.16 306.05 351.96 24147 662.62 629.49 723.91 # 24560 272.99 259.34 298.24 24149 1,156.27 1,098.46 1,263.23 24565 526.58 500.25 575.29 24150 981.83 932.74 1,072.65 # 24565 477.41 453.54 521.57 24151 1,137.58 1,080.70 1,242.81 24566 705.17 669.91 770.40 24152 730.56 694.03 798.13 24575 750.45 712.93 819.87 24153 681.15 647.09 744.15 24576 339.34 322.37 370.73 24155 847.27 804.91 925.65 # 24576 295.63 280.85 322.98 24160 616.07 585.27 673.06 24577 545.29 518.03 595.73 24164 505.95 480.65 552.75 # 24577 494.63 469.90 540.39 24200 218.87 207.93 239.12 24579 843.76 801.57 921.81 # 24200 139.91 132.91 152.85 24582 802.78 762.64 877.04 24201 612.11 581.50 668.73 24586 1,106.85 1,051.51 1,209.24 # 24201 370.74 352.20 405.03 24587 1,099.33 1,044.36 1,201.01 24220 203.37 193.20 222.18 24600 375.20 356.44 409.91 # 24220 69.27 65.81 75.68 # 24600 327.02 310.67 357.27 24300 417.32 396.45 455.92 24605 464.02 440.82 506.94 24301 762.43 724.31 832.96 24615 726.81 690.47 794.04 24305 591.18 561.62 645.86 24620 558.69 530.76 610.37 24310 484.95 460.70 529.81 24635 858.41 815.49 937.81 24320 769.57 731.09 840.75 24640 128.52 122.09 140.40 24330 728.71 692.27 796.11 # 24640 84.81 80.57 92.66 24331 800.36 760.34 874.39 24650 262.72 249.58 287.02 24332 609.81 579.32 666.22 # 24650 226.47 215.15 247.42 24340 625.12 593.86 682.94 24655 446.46 424.14 487.76 24341 731.70 695.12 799.39 # 24655 398.28 378.37 435.13 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 14 FSY08 LOCALITY FEE SCHEDULE FOR AREA 03 DATE 12/21/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 24665 662.01 628.91 723.25 25250 533.95 507.25 583.34 24666 743.89 706.70 812.71 25251 726.04 689.74 793.20 24670 293.23 278.57 320.36 25259 416.71 395.87 455.25 # 24670 253.00 240.35 276.40 25260 787.16 747.80 859.97 24675 465.29 442.03 508.33 25263 778.90 739.96 850.95 # 24675 419.60 398.62 458.41 25265 907.25 861.89 991.17 24685 664.36 631.14 725.81 25270 651.81 619.22 712.10 24800 812.27 771.66 887.41 25272 722.70 686.57 789.56 24802 997.80 947.91 1,090.10 25274 830.36 788.84 907.17 24900 714.06 678.36 780.11 25275 681.84 647.75 744.91 24920 702.48 667.36 767.46 25280 726.40 690.08 793.59 24925 546.67 519.34 597.24 25290 686.04 651.74 749.50 24930 739.75 702.76 808.17 25295 683.16 649.00 746.35 24931 768.86 730.42 839.98 25300 709.11 673.65 774.70 24935 1,068.14 1,014.73 1,166.94 25301 674.19 640.48 736.55 25000 400.22 380.21 437.24 25310 782.29 743.18 854.66 25001 341.94 324.84 373.57 25312 878.10 834.20 959.33 25020 636.34 604.52 695.20 25315 932.85 886.21 1,019.14 25023 1,169.12 1,110.66 1,277.26 25316 1,075.79 1,022.00 1,175.30 25024 757.50 719.63 827.57 25320 990.01 940.51 1,081.59 25025 1,142.32 1,085.20 1,247.98 25332 856.77 813.93 936.02 25028 557.02 529.17 608.55 25335 993.09 943.44 1,084.96 25031 441.35 419.28 482.17 25337 919.08 873.13 1,004.10 25035 764.05 725.85 834.73 25350 845.96 803.66 924.21 25040 595.97 566.17 651.10 25355 927.01 880.66 1,012.76 25065 260.50 247.48 284.60 25360 827.27 785.91 903.80 # 25065 169.11 160.65 184.75 25365 1,079.07 1,025.12 1,178.89 25066 428.64 407.21 468.29 25370 1,153.18 1,095.52 1,259.85 25075 370.81 352.27 405.11 25375 1,127.21 1,070.85 1,231.48 25076 526.79 500.45 575.52 25390 938.54 891.61 1,025.35 25077 826.29 784.98 902.73 25391 1,162.32 1,104.20 1,269.83 25085 501.43 476.36 547.81 25392 1,161.77 1,103.68 1,269.23 25100 373.66 354.98 408.23 25393 1,300.36 1,235.34 1,420.64 25101 433.79 412.10 473.92 25394 776.76 737.92 848.61 25105 528.48 502.06 577.37 25400 982.16 933.05 1,073.01 25107 642.15 610.04 701.55 25405 1,214.10 1,153.40 1,326.41 25109 516.10 490.30 563.85 25415 1,146.95 1,089.60 1,253.04 25110 415.29 394.53 453.71 25420 1,339.78 1,272.79 1,463.71 25111 336.74 319.90 367.89 25425 1,255.60 1,192.82 1,371.74 25112 404.91 384.66 442.36 25426 1,257.18 1,194.32 1,373.47 25115 900.63 855.60 983.94 25430 714.96 679.21 781.09 25116 758.87 720.93 829.07 25431 798.26 758.35 872.10 25118 412.90 392.26 451.10 25440 804.24 764.03 878.63 25119 545.42 518.15