1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 1 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 EFFECTIVE JANUARY 1, 2008-DECEMBER 31, 2008 DATE 07/17/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G0101 35.93 34.13 39.25 # G0268 30.04 28.54 32.82 G0102 20.47 19.45 22.37 G0270 24.56 23.33 26.83 # G0102 8.41 7.99 9.19 # G0270 24.16 22.95 26.39 G0104 131.06 124.51 143.19 G0271 13.91 13.21 15.19 # G0104 57.06 54.21 62.34 # G0271 13.51 12.83 14.75 G0105 384.07 364.87 419.60 G0275 13.51 12.83 14.75 # G0105 198.26 188.35 216.60 G0278 13.51 12.83 14.75 G0105 53 131.06 124.51 143.19 G0281 11.20 10.64 12.24 # G0105 53 57.06 54.21 62.34 G0283 11.20 10.64 12.24 G0106 188.30 178.89 205.72 G0288 238.83 226.89 260.92 G0106 TC 140.69 133.66 153.71 G0289 83.89 79.70 91.66 G0106 26 47.61 45.23 52.01 G0308 724.42 688.20 791.43 G0108 28.80 27.36 31.46 G0309 593.35 563.68 648.23 G0109 16.33 15.51 17.84 G0310 464.18 440.97 507.12 G0117 45.35 43.08 49.54 G0311 503.01 477.86 549.54 G0118 30.93 29.38 33.79 G0312 413.98 393.28 452.27 C G0120 184.68 175.45 201.77 G0313 324.84 308.60 354.89 C G0120 TC 137.07 130.22 149.75 G0314 442.98 420.83 483.95 G0120 26 47.61 45.23 52.01 G0315 364.23 346.02 397.92 G0121 384.07 364.87 419.60 G0316 283.01 268.86 309.19 # G0121 198.26 188.35 216.60 G0317 278.89 264.95 304.69 G0121 53 131.06 124.51 143.19 G0318 228.49 217.07 249.63 # G0121 53 57.06 54.21 62.34 G0319 178.47 169.55 194.98 G0124 25.13 23.87 27.45 G0320 563.99 535.79 616.16 G0127 18.86 17.92 20.61 G0321 399.50 379.53 436.46 # G0127 8.41 7.99 9.19 G0322 346.94 329.59 379.03 G0128 3.73 3.54 4.07 G0323 217.23 206.37 237.33 G0130 37.69 35.81 41.18 G0324 20.18 19.17 22.05 G0130 TC 27.35 25.98 29.88 G0325 11.93 11.33 13.03 G0130 26 10.34 9.82 11.29 G0326 13.87 13.18 15.16 G0141 25.13 23.87 27.45 G0327 7.66 7.28 8.37 G0166 165.03 156.78 180.30 G0329 8.19 7.78 8.95 G0168 86.85 82.51 94.89 G0332 79.23 75.27 86.56 # G0168 24.51 23.28 26.77 G0339 3,915.07 3,719.32 4,277.22 G0179 45.99 43.69 50.24 G0340 2,658.17 2,525.26 2,904.05 G0180 59.95 56.95 65.49 G0341 347.21 329.85 379.33 G0181 105.84 100.55 115.63 G0342 646.31 613.99 706.09 G0182 109.86 104.37 120.03 G0343 1,068.71 1,015.27 1,167.56 G0186 368.26 349.85 402.33 G0344 92.72 88.08 101.29 G0202 138.41 131.49 151.21 # G0344 65.77 62.48 71.85 G0202 TC 104.65 99.42 114.33 G0364 12.37 11.75 13.51 G0202 26 33.75 32.06 36.87 # G0364 8.75 8.31 9.56 G0204 156.47 148.65 170.95 C G0365 169.16 160.70 184.81 G0204 TC 114.31 108.59 124.88 C G0365 TC 157.02 149.17 171.55 G0204 26 42.16 40.05 46.06 G0365 26 12.14 11.53 13.26 G0206 124.89 118.65 136.45 G0366 23.37 22.20 25.53 G0206 TC 91.14 86.58 99.57 G0367 14.96 14.21 16.34 G0206 26 33.75 32.06 36.87 G0368 8.41 7.99 9.19 G0237 14.16 13.45 15.47 G0372 14.84 14.10 16.22 G0238 14.96 14.21 16.34 # G0372 8.01 7.61 8.75 G0239 13.35 12.68 14.58 G0389 119.15 113.19 130.17 G0245 63.08 59.93 68.92 G0389 TC 90.82 86.28 99.22 # G0245 42.56 40.43 46.49 G0389 26 28.33 26.91 30.95 G0246 37.95 36.05 41.46 G0392 2,443.15 2,320.99 2,669.14 # G0246 21.86 20.77 23.89 # G0392 474.79 451.05 518.71 G0247 41.49 39.42 45.33 G0393 1,859.27 1,766.31 2,031.26 # G0247 24.60 23.37 26.88 # G0393 303.97 288.77 332.09 G0248 201.74 191.65 220.40 G0396 29.74 28.25 32.49 G0249 148.25 140.84 161.97 # G0396 28.14 26.73 30.74 G0250 9.19 8.73 10.04 G0397 58.12 55.21 63.49 G0268 47.34 44.97 51.72 # G0397 56.11 53.30 61.30 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 99 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 23.24 22.08 25.39 10022 139.40 132.43 152.29 G9042 10.13 9.62 11.06 # 10022 61.38 58.31 67.06 G9043 10.13 9.62 11.06 10040 88.54 84.11 96.73 G9044 8.92 8.47 9.74 # 10040 76.87 73.03 83.98 M0064 37.83 35.94 41.33 10060 97.87 92.98 106.93 # M0064 16.52 15.69 18.04 # 10060 83.79 79.60 91.54 P3001 25.13 23.87 27.45 10061 166.40 158.08 181.79 Q0035 21.36 20.29 23.33 # 10061 148.30 140.89 162.02 Q0035 TC 13.35 12.68 14.58 10080 159.16 151.20 173.88 Q0035 26 8.01 7.61 8.75 # 10080 87.57 83.19 95.67 Q0091 41.70 39.62 45.56 10081 241.44 229.37 263.78 # Q0091 17.97 17.07 19.63 # 10081 148.53 141.10 162.27 Q0092 16.33 15.51 17.84 10120 127.17 120.81 138.93 R0070 191.66 182.08 209.39 # 10120 82.93 78.78 90.60 R0075 191.66 182.08 209.39 10121 240.81 228.77 263.09 0016T 368.26 349.85 402.33 # 10121 168.81 160.37 184.43 0030T 26.31 24.99 28.74 10140 137.99 131.09 150.75 0067T 442.34 420.22 483.25 # 10140 108.63 103.20 118.68 C 0067T TC 195.88 186.09 214.00 10160 113.60 107.92 124.11 0067T 26 63.47 60.30 69.35 # 10160 87.86 83.47 95.99 0073T 630.57 599.04 688.90 10180 210.64 200.11 230.13 0075T 1,109.13 1,053.67 1,211.72 # 10180 161.17 153.11 176.08 0075T 26 904.50 859.28 988.17 11000 48.16 45.75 52.61 0076T 366.01 347.71 399.87 # 11000 29.66 28.18 32.41 0076T 26 90.45 85.93 98.82 11001 20.19 19.18 22.06 0078T 1,381.63 1,312.55 1,509.43 # 11001 14.96 14.21 16.34 0079T 133.23 126.57 145.56 11004 523.70 497.52 572.15 0080T 243.68 231.50 266.23 11005 691.96 657.36 755.96 0081T 24.37 23.15 26.62 11006 650.48 617.96 710.65 0144T 321.60 305.52 351.35 11008 250.25 237.74 273.40 C 0144T TC 103.21 98.05 112.76 11010 432.57 410.94 472.58 0144T 26 60.30 57.29 65.88 # 11010 257.21 244.35 281.00 0145T 477.38 453.51 521.54 11011 490.38 465.86 535.74 C 0145T TC 306.00 290.70 334.31 # 11011 272.39 258.77 297.59 0145T 26 75.38 71.61 82.35 11012 684.77 650.53 748.11 0146T 633.15 601.49 691.71 # 11012 399.61 379.63 436.57 C 0146T TC 306.00 290.70 334.31 11040 42.46 40.34 46.39 0146T 26 100.50 95.48 109.80 # 11040 25.56 24.28 27.92 0147T 633.15 601.49 691.71 11041 50.49 47.97 55.17 C 0147T TC 306.00 290.70 334.31 # 11041 33.20 31.54 36.27 0147T 26 100.50 95.48 109.80 11042 68.60 65.17 74.95 0148T 633.15 601.49 691.71 # 11042 43.66 41.48 47.70 C 0148T TC 306.00 290.70 334.31 11043 248.87 236.43 271.89 0148T 26 100.50 95.48 109.80 # 11043 215.09 204.34 234.99 0149T 633.15 601.49 691.71 11044 336.25 319.44 367.36 C 0149T TC 306.00 290.70 334.31 # 11044 296.83 281.99 324.29 0149T 26 100.50 95.48 109.80 11055 43.13 40.97 47.12 0150T 633.15 601.49 691.71 # 11055 21.41 20.34 23.39 C 0150T TC 306.00 290.70 334.31 11056 52.97 50.32 57.87 0150T 26 100.50 95.48 109.80 # 11056 30.04 28.54 32.82 0151T 201.00 190.95 219.59 11057 63.85 60.66 69.76 C 0151T TC 103.21 98.05 112.76 # 11057 39.32 37.35 42.95 0151T 26 60.30 57.29 65.88 11100 90.70 86.17 99.10 0159T 17.72 16.83 19.35 # 11100 43.24 41.08 47.24 0159T TC 14.72 13.98 16.08 11101 29.17 27.71 31.87 0159T 26 2.99 2.84 3.27 # 11101 21.93 20.83 23.95 0171T 753.36 715.69 823.04 11200 73.26 69.60 80.04 0172T 376.68 357.85 411.53 # 11200 61.20 58.14 66.86 0177T 1,260.67 1,197.64 1,377.29 11201 16.89 16.05 18.46 10021 132.65 126.02 144.92 # 11201 15.28 14.52 16.70 # 10021 63.87 60.68 69.78 11300 61.82 58.73 67.54 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 99 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 26.43 25.11 28.88 11451 420.72 399.68 459.63 11301 82.42 78.30 90.05 # 11451 269.49 256.02 294.42 # 11301 45.01 42.76 49.17 11462 316.24 300.43 345.49 11302 98.03 93.13 107.10 # 11462 196.39 186.57 214.56 # 11302 55.40 52.63 60.52 11463 428.60 407.17 468.25 11303 116.29 110.48 127.05 # 11463 272.95 259.30 298.20 # 11303 65.21 61.95 71.24 11470 345.12 327.86 377.04 11305 62.93 59.78 68.75 # 11470 231.70 220.12 253.14 # 11305 33.97 32.27 37.11 11471 442.48 420.36 483.41 11306 85.73 81.44 93.66 # 11471 292.86 278.22 319.95 # 11306 51.15 48.59 55.88 11600 163.92 155.72 179.08 11307 99.97 94.97 109.22 # 11600 97.96 93.06 107.02 # 11307 59.35 56.38 64.84 11601 194.64 184.91 212.65 11308 114.25 108.54 124.82 # 11601 125.87 119.58 137.52 # 11308 72.42 68.80 79.12 11602 212.02 201.42 231.63 11310 75.79 72.00 82.80 # 11602 136.81 129.97 149.47 # 11310 38.38 36.46 41.93 11603 240.63 228.60 262.89 11311 94.01 89.31 102.71 # 11603 161.80 153.71 176.77 # 11311 55.80 53.01 60.96 11604 265.55 252.27 290.11 11312 109.27 103.81 119.38 # 11604 177.07 168.22 193.45 # 11312 64.22 61.01 70.16 11606 368.93 350.48 403.05 11313 137.70 130.82 150.44 # 11606 261.14 248.08 285.29 # 11313 86.22 81.91 94.20 11620 165.27 157.01 180.56 11400 109.01 103.56 119.09 # 11620 98.90 93.96 108.05 # 11400 67.58 64.20 73.83 11621 196.23 186.42 214.38 11401 129.87 123.38 141.89 # 11621 127.46 121.09 139.25 # 11401 88.44 84.02 96.62 11622 221.11 210.05 241.56 11402 143.99 136.79 157.31 # 11622 146.30 138.99 159.84 # 11402 96.93 92.08 105.89 11623 258.02 245.12 281.89 11403 164.83 156.59 180.08 # 11623 179.19 170.23 195.76 # 11403 123.00 116.85 134.38 11624 291.45 276.88 318.41 11404 187.07 177.72 204.38 # 11624 204.57 194.34 223.49 # 11404 135.99 129.19 148.57 11626 358.10 340.20 391.23 11406 257.81 244.92 281.66 # 11626 259.97 246.97 284.02 # 11406 200.30 190.29 218.83 11640 172.53 163.90 188.49 11420 108.32 102.90 118.34 # 11640 105.77 100.48 115.55 # 11420 73.33 69.66 80.11 11641 209.52 199.04 228.90 11421 137.92 131.02 150.67 # 11641 138.73 131.79 151.56 # 11421 97.70 92.82 106.74 11642 240.89 228.85 263.18 11422 153.99 146.29 168.23 # 11642 162.86 154.72 177.93 # 11422 116.99 111.14 127.81 11643 282.68 268.55 308.83 11423 179.26 170.30 195.85 # 11643 202.24 192.13 220.95 # 11423 135.82 129.03 148.38 11644 350.18 332.67 382.57 11424 205.12 194.86 224.09 # 11644 252.85 240.21 276.24 # 11424 156.85 149.01 171.36 11646 459.01 436.06 501.47 11426 289.54 275.06 316.32 # 11646 357.25 339.39 390.30 # 11426 236.05 224.25 257.89 11719 18.70 17.77 20.44 11440 120.91 114.86 132.09 # 11719 8.65 8.22 9.45 # 11440 89.14 84.68 97.38 11720 27.79 26.40 30.36 11441 148.68 141.25 162.44 # 11720 15.73 14.94 17.18 # 11441 114.90 109.16 125.53 11721 39.81 37.82 43.49 11442 166.71 158.37 182.13 # 11721 26.94 25.59 29.43 # 11442 127.30 120.94 139.08 11730 88.04 83.64 96.19 11443 199.81 189.82 218.29 # 11730 55.06 52.31 60.16 # 11443 156.77 148.93 171.27 11732 40.57 38.54 44.32 11444 250.61 238.08 273.79 # 11732 28.11 26.70 30.71 # 11444 199.94 189.94 218.43 11740 40.57 38.54 44.32 11446 334.40 317.68 365.33 # 11740 29.31 27.84 32.02 # 11446 280.50 266.48 306.45 11750 189.20 179.74 206.70 11450 318.77 302.83 348.25 # 11750 159.44 151.47 174.19 # 11450 203.74 193.55 222.58 11752 267.79 254.40 292.56 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 31140 PAGE 4 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 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 241.65 229.57 264.01 12013 159.51 151.53 174.26 11755 119.88 113.89 130.97 # 12013 108.83 103.39 118.90 # 11755 78.05 74.15 85.27 12014 186.90 177.56 204.19 11760 180.21 171.20 196.88 # 12014 130.19 123.68 142.23 # 11760 123.90 117.71 135.37 12015 234.59 222.86 256.29 11762 239.20 227.24 261.33 # 12015 163.00 154.85 178.08 # 11762 187.72 178.33 205.08 12016 277.16 263.30 302.80 11765 115.78 109.99 126.49 # 12016 198.33 188.41 216.67 # 11765 61.49 58.42 67.18 12017 239.68 227.70 261.86 11770 236.51 224.68 258.38 12018 286.68 272.35 313.20 # 11770 157.68 149.80 172.27 12020 247.45 235.08 270.34 11771 466.94 443.59 510.13 # 12020 170.23 161.72 185.98 # 11771 360.76 342.72 394.13 12021 142.70 135.57 155.91 11772 578.31 549.39 631.80 # 12021 123.80 117.61 135.25 # 11772 479.37 455.40 523.71 12031 201.64 191.56 220.29 11900 49.50 47.03 54.08 # 12031 132.46 125.84 144.72 # 11900 27.38 26.01 29.91 12032 270.05 256.55 295.03 11901 60.95 57.90 66.59 # 12032 169.91 161.41 185.62 # 11901 42.45 40.33 46.38 12034 262.23 249.12 286.49 11920 181.72 172.63 198.52 # 12034 174.55 165.82 190.69 # 11920 104.10 98.90 113.74 12035 336.78 319.94 367.93 11921 205.33 195.06 224.32 # 12035 211.30 200.74 230.85 # 11921 122.88 116.74 134.25 12036 370.99 352.44 405.31 11922 59.61 56.63 65.12 # 12036 246.71 234.37 269.53 # 11922 27.84 26.45 30.42 12037 416.88 396.04 455.45 11950 70.45 66.93 76.97 # 12037 286.57 272.24 313.08 # 11950 44.71 42.47 48.84 12041 214.24 203.53 234.06 11951 91.19 86.63 99.62 # 12041 143.45 136.28 156.72 # 11951 60.22 57.21 65.79 12042 253.36 240.69 276.79 11952 130.99 124.44 143.11 # 12042 169.30 160.84 184.97 # 11952 89.97 85.47 98.29 12044 286.49 272.17 313.00 11954 153.82 146.13 168.05 # 12044 184.33 175.11 201.38 # 11954 101.94 96.84 111.37 12045 340.15 323.14 371.61 11960 825.57 784.29 901.93 # 12045 220.29 209.28 240.67 11970 538.11 511.20 587.88 12046 401.40 381.33 438.53 11971 448.48 426.06 489.97 # 12046 258.22 245.31 282.11 # 11971 273.53 259.85 298.83 12047 429.47 408.00 469.20 11976 134.46 127.74 146.90 # 12047 286.69 272.36 313.21 # 11976 88.61 84.18 96.81 12051 237.24 225.38 259.19 11980 96.44 91.62 105.36 # 12051 156.80 148.96 171.30 # 11980 73.51 69.83 80.30 12052 261.33 248.26 285.50 11981 125.15 118.89 136.72 # 12052 179.28 170.32 195.87 # 11981 78.10 74.20 85.33 12053 285.54 271.26 311.95 11982 143.96 136.76 157.27 # 12053 185.40 176.13 202.55 # 11982 94.89 90.15 103.67 12054 305.60 290.32 333.87 11983 216.10 205.30 236.10 # 12054 198.61 188.68 216.98 # 11983 173.07 164.42 189.08 12055 371.98 353.38 406.39 12001 136.34 129.52 148.95 # 12055 245.69 233.41 268.42 # 12001 91.70 87.12 100.19 12056 459.30 436.34 501.79 12002 144.99 137.74 158.40 # 12056 304.86 289.62 333.06 # 12002 102.76 97.62 112.26 12057 494.79 470.05 540.56 12004 169.88 161.39 185.60 # 12057 349.60 332.12 381.94 # 12004 120.41 114.39 131.55 13100 283.05 268.90 309.24 12005 211.32 200.75 230.86 # 13100 208.64 198.21 227.94 # 12005 149.39 141.92 163.21 13101 352.15 334.54 384.72 12006 262.63 249.50 286.93 # 13101 252.80 240.16 276.18 # 12006 189.03 179.58 206.52 13102 95.62 90.84 104.47 12007 294.86 280.12 322.14 # 13102 67.07 63.72 73.28 # 12007 216.43 205.61 236.45 13120 293.63 278.95 320.79 12011 145.32 138.05 158.76 # 13120 217.21 206.35 237.30 # 12011 95.05 90.30 103.85 13121 385.79 366.50 421.48 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 5 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 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 282.82 268.68 308.98 15120 842.15 800.04 920.05 13122 110.25 104.74 120.45 # 15120 704.60 669.37 769.78 # 13122 76.46 72.64 83.54 15121 258.50 245.58 282.42 13131 323.39 307.22 353.30 # 15121 161.97 153.87 176.95 # 13131 246.57 234.24 269.38 15130 632.23 600.62 690.71 13132 504.24 479.03 550.88 # 15130 513.58 487.90 561.09 # 13132 410.13 389.62 448.06 15131 90.29 85.78 98.65 13133 149.56 142.08 163.39 # 15131 78.22 74.31 85.46 # 13133 118.59 112.66 129.56 15135 787.61 748.23 860.46 13150 330.13 313.62 360.66 # 15135 703.55 668.37 768.63 # 13150 247.28 234.92 270.16 15136 86.43 82.11 94.43 13151 365.75 347.46 399.58 # 15136 79.19 75.23 86.51 # 13151 286.11 271.80 312.57 15150 653.35 620.68 713.78 13152 496.76 471.92 542.71 # 15150 586.99 557.64 641.29 # 13152 383.75 364.56 419.24 15151 118.10 112.20 129.03 13153 166.38 158.06 181.77 # 15151 104.83 99.59 114.53 # 13153 129.78 123.29 141.78 15152 145.12 137.86 158.54 13160 722.37 686.25 789.19 # 15152 131.04 124.49 143.16 14000 582.60 553.47 636.49 15155 676.09 642.29 738.63 # 14000 476.42 452.60 520.49 # 15155 631.84 600.25 690.29 14001 754.94 717.19 824.77 15156 155.81 148.02 170.22 # 14001 636.69 604.86 695.59 # 15156 145.35 138.08 158.79 14020 649.19 616.73 709.24 15157 173.41 164.74 189.45 # 14020 544.22 517.01 594.56 # 15157 158.53 150.60 173.19 14021 849.01 806.56 927.54 15170 373.07 354.42 407.58 # 14021 738.00 701.10 806.27 # 15170 315.15 299.39 344.30 14040 682.03 647.93 745.12 15171 82.49 78.37 90.13 # 14040 585.50 556.23 639.66 # 15171 78.47 74.55 85.73 14041 931.91 885.31 1,018.11 15175 488.90 464.46 534.13 # 14041 808.03 767.63 882.77 # 15175 433.40 411.73 473.49 14060 694.50 659.78 758.75 15176 132.88 126.24 145.18 # 14060 616.87 586.03 673.93 # 15176 125.64 119.36 137.26 14061 1,011.84 961.25 1,105.44 15200 715.18 679.42 781.33 # 14061 875.89 832.10 956.92 # 15200 579.24 550.28 632.82 14300 971.89 923.30 1,061.80 15201 141.18 134.12 154.24 # 14300 850.43 807.91 929.10 # 15201 70.80 67.26 77.35 14350 680.21 646.20 743.13 15220 684.12 649.91 747.40 15002 304.68 289.45 332.87 # 15220 557.83 529.94 609.43 # 15002 202.92 192.77 221.69 15221 131.01 124.46 143.13 15003 65.70 62.42 71.78 # 15221 65.45 62.18 71.51 # 15003 39.96 37.96 43.65 15240 812.34 771.72 887.48 15004 365.81 347.52 399.65 # 15240 704.15 668.94 769.28 # 15004 250.78 238.24 273.98 15241 168.60 160.17 184.20 15005 109.26 103.80 119.37 # 15241 103.04 97.89 112.57 # 15005 80.71 76.67 88.17 15260 868.70 825.27 949.06 15040 244.23 232.02 266.82 # 15260 761.72 723.63 832.17 # 15040 117.14 111.28 127.97 15261 194.47 184.75 212.46 15050 487.57 463.19 532.67 # 15261 131.73 125.14 143.91 # 15050 398.69 378.76 435.57 15300 302.23 287.12 330.19 15100 809.64 769.16 884.53 # 15300 256.78 243.94 280.53 # 15100 651.58 619.00 711.85 15301 55.63 52.85 60.78 15101 188.39 178.97 205.82 # 15301 51.61 49.03 56.38 # 15101 104.33 99.11 113.98 15320 343.85 326.66 375.66 15110 789.60 750.12 862.64 # 15320 293.57 278.89 320.72 # 15110 667.73 634.34 729.49 15321 83.45 79.28 91.17 15111 112.23 106.62 122.61 # 15321 77.82 73.93 85.02 # 15111 96.95 92.10 105.92 15330 280.79 266.75 306.76 15115 776.78 737.94 848.63 # 15330 234.13 222.42 255.78 # 15115 689.10 654.65 752.85 15331 56.04 53.24 61.23 15116 148.25 140.84 161.97 # 15331 52.42 49.80 57.27 # 15116 132.16 125.55 144.38 15335 301.91 286.81 329.83 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 99 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 254.85 242.11 278.43 15770 588.16 558.75 642.56 15336 81.71 77.62 89.26 15775 289.21 274.75 315.96 # 15336 74.87 71.13 81.80 # 15775 196.70 186.87 214.90 15340 291.30 276.74 318.25 15776 409.69 389.21 447.59 # 15340 245.44 233.17 268.15 # 15776 303.51 288.33 331.58 15341 43.26 41.10 47.27 15780 761.15 723.09 831.55 # 15341 25.16 23.90 27.49 # 15780 600.67 570.64 656.24 15360 330.51 313.98 361.08 15781 487.61 463.23 532.71 # 15360 276.21 262.40 301.76 # 15781 395.51 375.73 432.09 15361 63.84 60.65 69.75 15782 529.13 502.67 578.07 # 15361 57.80 54.91 63.15 # 15782 387.15 367.79 422.96 15365 329.56 313.08 360.04 15783 450.52 427.99 492.19 # 15365 280.09 266.09 306.00 # 15783 337.10 320.25 368.29 15366 80.55 76.52 88.00 15786 218.07 207.17 238.25 # 15366 74.51 70.78 81.40 # 15786 123.56 117.38 134.99 15400 340.38 323.36 371.86 15787 50.70 48.17 55.40 # 15400 315.85 300.06 345.07 # 15787 16.91 16.06 18.47 15401 95.45 90.68 104.28 15788 398.61 378.68 435.48 # 15401 52.82 50.18 57.71 # 15788 218.02 207.12 238.19 15420 383.38 364.21 418.84 15789 522.84 496.70 571.21 # 15420 337.94 321.04 369.20 # 15789 384.49 365.27 420.06 15421 105.57 100.29 115.33 15792 389.41 369.94 425.43 # 15421 77.82 73.93 85.02 # 15792 247.83 235.44 270.76 15430 488.03 463.63 533.17 15793 423.04 401.89 462.17 # 15430 471.14 447.58 514.72 # 15793 320.08 304.08 349.69 15570 800.61 760.58 874.67 15819 655.00 622.25 715.59 # 15570 632.49 600.87 691.00 15820 483.90 459.71 528.67 15572 752.29 714.68 821.88 # 15820 431.62 410.04 471.55 # 15572 628.41 596.99 686.54 15821 515.55 489.77 563.24 15574 811.27 770.71 886.32 # 15821 456.83 433.99 499.09 # 15574 682.56 648.43 745.69 15822 383.61 364.43 419.09 15576 724.14 687.93 791.12 # 15822 333.74 317.05 364.61 # 15576 602.68 572.55 658.43 15823 592.78 563.14 647.61 15600 332.31 315.69 363.04 # 15823 538.48 511.56 588.29 # 15600 189.53 180.05 207.06 15830 1,036.41 984.59 1,132.28 15610 298.01 283.11 325.58 15832 801.57 761.49 875.71 # 15610 221.99 210.89 242.52 15833 747.15 709.79 816.26 15620 417.57 396.69 456.19 15834 762.07 723.97 832.57 # 15620 287.25 272.89 313.82 15835 780.19 741.18 852.36 15630 425.63 404.35 465.00 15836 657.96 625.06 718.82 # 15630 311.81 296.22 340.65 15837 691.61 657.03 755.58 15650 456.99 434.14 499.26 # 15837 609.56 579.08 665.94 # 15650 339.95 322.95 371.39 15838 518.37 492.45 566.32 15731 986.26 936.95 1,077.49 15839 752.14 714.53 821.71 # 15731 883.30 839.14 965.01 # 15839 636.71 604.87 695.60 15732 1,371.73 1,303.14 1,498.61 15840 910.55 865.02 994.77 # 15732 1,182.69 1,123.56 1,292.09 15841 1,503.07 1,427.92 1,642.11 15734 1,406.13 1,335.82 1,536.19 15842 2,374.33 2,255.61 2,593.95 # 15734 1,213.48 1,152.81 1,325.73 15845 849.15 806.69 927.69 15736 1,267.15 1,203.79 1,384.36 15851 91.33 86.76 99.77 # 15736 1,049.56 997.08 1,146.64 # 15851 41.46 39.39 45.30 15738 1,341.89 1,274.80 1,466.02 15852 42.99 40.84 46.97 # 15738 1,144.01 1,086.81 1,249.83 15860 101.04 95.99 110.39 15740 883.04 838.89 964.72 15920 519.69 493.71 567.77 # 15740 761.58 723.50 832.03 15922 669.04 635.59 730.93 15750 824.20 782.99 900.44 15931 592.98 563.33 647.83 15756 2,139.40 2,032.43 2,337.29 15933 733.16 696.50 800.98 15757 2,136.14 2,029.33 2,333.73 15934 817.33 776.46 892.93 15758 2,129.48 2,023.01 2,326.46 15935 969.06 920.61 1,058.70 15760 758.75 720.81 828.93 15936 797.56 757.68 871.33 # 15760 635.27 603.51 694.04 15937 933.90 887.21 1,020.29 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 99 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 613.90 583.21 670.69 17276 250.34 237.82 273.49 15941 813.10 772.45 888.32 # 17276 185.99 176.69 203.19 15944 790.70 751.17 863.85 17280 121.52 115.44 132.76 15945 874.23 830.52 955.10 # 17280 78.48 74.56 85.74 15946 1,445.13 1,372.87 1,578.80 17281 153.68 146.00 167.90 15950 510.03 484.53 557.21 # 17281 109.04 103.59 119.13 15951 727.10 690.75 794.36 17282 177.93 169.03 194.38 15952 754.71 716.97 824.52 # 17282 126.05 119.75 137.71 15953 842.35 800.23 920.26 17283 215.07 204.32 234.97 15956 1,022.59 971.46 1,117.18 # 17283 157.96 150.06 172.57 15958 1,045.35 993.08 1,142.04 17284 250.82 238.28 274.02 16000 63.62 60.44 69.51 # 17284 188.08 178.68 205.48 # 16000 41.90 39.81 45.78 17286 319.19 303.23 348.71 16020 77.04 73.19 84.17 # 17286 255.24 242.48 278.85 # 16020 51.70 49.12 56.49 17311 645.96 613.66 705.71 16025 134.27 127.56 146.69 # 17311 337.88 320.99 369.14 # 16025 103.70 98.52 113.30 17312 391.86 372.27 428.11 16030 161.65 153.57 176.61 # 17312 179.90 170.91 196.55 # 16030 119.02 113.07 130.03 17313 590.62 561.09 645.25 16035 193.60 183.92 211.51 # 17313 303.45 288.28 331.52 16036 76.77 72.93 83.87 17314 362.27 344.16 395.78 17000 69.68 66.20 76.13 # 17314 166.40 158.08 181.79 # 17000 47.56 45.18 51.96 17315 76.11 72.30 83.15 17003 6.97 6.62 7.61 # 17315 47.55 45.17 51.95 # 17003 4.55 4.32 4.97 17340 41.38 39.31 45.21 17004 159.34 151.37 174.08 # 17340 41.79 39.70 45.66 # 17004 123.55 117.37 134.98 17360 116.52 110.69 127.29 17106 351.57 333.99 384.09 # 17360 87.96 83.56 96.09 # 17106 297.68 282.80 325.22 19000 108.74 103.30 118.80 17107 610.65 580.12 667.14 # 19000 41.98 39.88 45.86 # 17107 534.64 507.91 584.10 19001 25.21 23.95 27.54 17108 824.27 783.06 900.52 # 19001 20.79 19.75 22.71 # 17108 742.22 705.11 810.88 19020 397.67 377.79 434.46 17110 92.21 87.60 100.74 # 19020 252.08 239.48 275.40 # 17110 55.61 52.83 60.75 19030 165.36 157.09 180.65 17111 111.87 106.28 122.22 # 19030 74.86 71.12 81.79 # 17111 71.65 68.07 78.28 19100 130.48 123.96 142.55 17250 69.40 65.93 75.82 # 19100 61.70 58.62 67.41 # 17250 32.80 31.16 35.83 19101 296.15 281.34 323.54 17260 86.31 81.99 94.29 # 19101 191.98 182.38 209.74 # 17260 60.17 57.16 65.73 19102 217.69 206.81 237.83 17261 123.93 117.73 135.39 # 19102 97.83 92.94 106.88 # 17261 79.69 75.71 87.07 19103 566.27 537.96 618.65 17262 150.45 142.93 164.37 # 19103 180.56 171.53 197.26 # 17262 101.78 96.69 111.19 19105 2,002.52 1,902.39 2,187.75 17263 165.64 157.36 180.96 # 19105 172.11 163.50 188.03 # 17263 112.14 106.53 122.51 19110 399.16 379.20 436.08 17264 178.89 169.95 195.44 # 19110 280.51 266.48 306.45 # 17264 119.76 113.77 130.84 19112 384.74 365.50 420.33 17266 202.61 192.48 221.35 # 19112 254.43 241.71 277.97 # 17266 138.26 131.35 151.05 19120 408.22 387.81 445.98 17270 129.72 123.23 141.71 # 19120 343.87 326.68 375.68 # 17270 85.88 81.59 93.83 19125 449.71 427.22 491.30 17271 141.75 134.66 154.86 # 19125 381.33 362.26 416.60 # 17271 96.70 91.87 105.65 19126 143.12 135.96 156.35 17272 162.44 154.32 177.47 19260 1,074.50 1,020.78 1,173.90 # 17272 112.16 106.55 122.53 19271 1,481.53 1,407.45 1,618.57 17273 180.73 171.69 197.44 19272 1,632.80 1,551.16 1,783.83 # 17273 126.03 119.73 137.69 19290 160.08 152.08 174.89 17274 214.91 204.16 234.78 # 19290 61.94 58.84 67.67 # 17274 154.58 146.85 168.88 19291 69.12 65.66 75.51 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 99 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 30.51 28.98 33.33 # 20225 112.03 106.43 122.39 19295 100.39 95.37 109.68 20240 212.42 201.80 232.07 19296 4,384.68 4,165.45 4,790.27 20245 575.48 546.71 628.72 # 19296 186.12 176.81 203.33 20250 342.34 325.22 374.00 19297 83.74 79.55 91.48 20251 380.80 361.76 416.02 19298 1,503.95 1,428.75 1,643.06 20500 117.48 111.61 128.35 # 19298 303.79 288.60 331.89 # 20500 93.35 88.68 101.98 19300 497.99 473.09 544.05 20501 132.84 126.20 145.13 # 19300 338.32 321.40 369.61 # 20501 37.12 35.26 40.55 19301 518.66 492.73 566.64 20520 179.36 170.39 195.95 19302 763.12 724.96 833.70 # 20520 133.11 126.45 145.42 19303 799.49 759.52 873.45 20525 457.82 434.93 500.17 19304 484.05 459.85 528.83 # 20525 228.16 216.75 249.26 19305 951.80 904.21 1,039.84 20526 70.77 67.23 77.31 19306 994.21 944.50 1,086.18 # 20526 53.47 50.80 58.42 19307 999.27 949.31 1,091.71 20550 54.43 51.71 59.47 19316 701.27 666.21 766.14 # 20550 37.94 36.04 41.45 19318 1,032.00 980.40 1,127.46 20551 53.79 51.10 58.77 19324 433.26 411.60 473.34 # 20551 39.71 37.72 43.38 19325 579.99 550.99 633.64 20552 49.60 47.12 54.19 19328 437.87 415.98 478.38 # 20552 32.30 30.69 35.29 19330 555.18 527.42 606.53 20553 55.64 52.86 60.79 19340 358.28 340.37 391.43 # 20553 35.93 34.13 39.25 19342 822.42 781.30 898.50 20555 300.57 285.54 328.37 19350 815.22 774.46 890.63 20600 50.72 48.18 55.41 # 19350 614.52 583.79 671.36 # 20600 37.45 35.58 40.92 19355 660.02 627.02 721.07 20605 55.11 52.35 60.20 # 19355 493.51 468.83 539.15 # 20605 38.62 36.69 42.19 19357 1,389.39 1,319.92 1,517.91 20610 70.13 66.62 76.61 19361 1,441.18 1,369.12 1,574.49 # 20610 45.99 43.69 50.24 19364 2,502.63 2,377.50 2,734.13 20612 54.35 51.63 59.37 19366 1,243.78 1,181.59 1,358.83 # 20612 39.87 37.88 43.56 19367 1,637.30 1,555.44 1,788.76 20615 207.77 197.38 226.99 19368 2,012.31 1,911.69 2,198.44 # 20615 148.25 140.84 161.97 19369 1,855.34 1,762.57 2,026.96 20650 180.36 171.34 197.04 19370 610.42 579.90 666.89 # 20650 143.76 136.57 157.06 19371 703.31 668.14 768.36 20660 240.95 228.90 263.24 19380 687.66 653.28 751.27 # 20660 211.59 201.01 231.16 19396 193.52 183.84 211.42 20661 421.67 400.59 460.68 # 19396 126.35 120.03 138.03 20662 432.79 411.15 472.82 20000 188.34 178.92 205.76 20663 407.21 386.85 444.88 # 20000 143.70 136.52 157.00 20664 674.00 640.30 736.35 20005 275.14 261.38 300.59 20665 120.25 114.24 131.38 # 20005 216.82 205.98 236.88 # 20665 96.12 91.31 105.01 20100 539.92 512.92 589.86 20670 431.41 409.84 471.32 20101 371.33 352.76 405.67 # 20670 142.22 135.11 155.38 # 20101 182.69 173.56 199.59 20680 553.62 525.94 604.83 20102 435.29 413.53 475.56 # 20680 369.42 350.95 403.59 # 20102 220.51 209.48 240.90 20690 455.72 432.93 497.87 20103 527.41 501.04 576.20 20692 838.85 796.91 916.45 # 20103 321.88 305.79 351.66 20693 425.30 404.04 464.65 20150 837.70 795.82 915.19 20694 409.62 389.14 447.51 20200 178.10 169.20 194.58 # 20694 311.08 295.53 339.86 # 20200 83.99 79.79 91.76 20802 2,208.67 2,098.24 2,412.98 20205 242.61 230.48 265.05 20805 2,896.33 2,751.51 3,164.24 # 20205 133.21 126.55 145.53 20808 3,745.90 3,558.61 4,092.40 20206 270.75 257.21 295.79 20816 2,270.93 2,157.38 2,480.99 # 20206 59.19 56.23 64.66 20822 1,992.73 1,893.09 2,177.05 20220 190.89 181.35 208.55 20824 2,244.95 2,132.70 2,452.61 # 20220 74.25 70.54 81.12 20827 2,039.16 1,937.20 2,227.78 20225 801.80 761.71 875.97 20838 2,194.93 2,085.18 2,397.96 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 99 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 572.68 544.05 625.66 # 21076 796.48 756.66 870.16 # 20900 430.30 408.79 470.11 21077 2,249.52 2,137.04 2,457.60 20902 559.63 531.65 611.40 # 21077 2,009.81 1,909.32 2,195.72 20910 395.98 376.18 432.61 21079 1,543.45 1,466.28 1,686.22 20912 449.34 426.87 490.90 # 21079 1,337.93 1,271.03 1,461.68 20920 371.02 352.47 405.34 21080 1,754.69 1,666.96 1,917.00 20922 551.45 523.88 602.46 # 21080 1,508.14 1,432.73 1,647.64 # 20922 446.08 423.78 487.35 21081 1,600.09 1,520.09 1,748.10 20924 465.96 442.66 509.06 # 21081 1,370.03 1,301.53 1,496.76 20926 399.36 379.39 436.30 21082 1,468.09 1,394.69 1,603.89 20931 103.54 98.36 113.11 # 21082 1,262.17 1,199.06 1,378.92 20937 158.07 150.17 172.70 21083 1,398.75 1,328.81 1,528.13 20938 171.77 163.18 187.66 # 21083 1,167.49 1,109.12 1,275.49 20950 270.22 256.71 295.22 21084 1,602.60 1,522.47 1,750.84 # 20950 85.21 80.95 93.09 # 21084 1,348.41 1,280.99 1,473.14 20955 2,331.41 2,214.84 2,547.07 21085 640.50 608.48 699.75 20956 2,458.98 2,336.03 2,686.43 # 21085 541.56 514.48 591.65 20957 2,301.17 2,186.11 2,514.03 21086 1,667.79 1,584.40 1,822.06 20962 2,445.46 2,323.19 2,671.67 # 21086 1,491.22 1,416.66 1,629.16 20969 2,599.76 2,469.77 2,840.24 21087 1,654.43 1,571.71 1,807.47 20970 2,586.37 2,457.05 2,825.61 # 21087 1,481.89 1,407.80 1,618.97 20972 2,335.11 2,218.35 2,551.10 21088 2,795.68 2,655.90 3,054.29 20973 2,510.92 2,385.37 2,743.18 21100 693.29 658.63 757.42 20974 57.13 54.27 62.41 # 21100 369.12 350.66 403.26 # 20974 44.26 42.05 48.36 21110 668.26 634.85 730.08 20975 163.69 155.51 178.84 # 21110 577.36 548.49 630.76 20979 51.82 49.23 56.61 21116 166.23 157.92 181.61 # 20979 34.13 32.42 37.28 # 21116 39.94 37.94 43.63 20982 4,076.98 3,873.13 4,454.10 21120 589.89 560.40 644.46 # 20982 375.95 357.15 410.72 # 21120 467.22 443.86 510.44 20985 135.79 129.00 148.35 21121 691.61 657.03 755.58 21010 664.07 630.87 725.50 # 21121 591.87 562.28 646.62 21015 393.03 373.38 429.39 21122 659.27 626.31 720.26 21025 904.55 859.32 988.22 21123 771.50 732.93 842.87 # 21025 769.81 731.32 841.02 21125 2,777.91 2,639.01 3,034.86 21026 537.49 510.62 587.21 # 21125 676.42 642.60 738.99 # 21026 448.20 425.79 489.66 21127 3,021.41 2,870.34 3,300.89 21029 682.41 648.29 745.53 # 21127 791.22 751.66 864.41 # 21029 573.82 545.13 626.90 21137 678.87 644.93 741.67 21030 447.16 424.80 488.52 21138 820.51 779.48 896.40 # 21030 370.74 352.20 405.03 21139 894.88 850.14 977.66 21031 344.48 327.26 376.35 21141 1,221.05 1,160.00 1,334.00 # 21031 264.45 251.23 288.91 21142 1,193.27 1,133.61 1,303.65 21032 351.44 333.87 383.95 21143 1,266.08 1,202.78 1,383.20 # 21032 260.55 247.52 284.65 21145 1,407.90 1,337.51 1,538.14 21034 1,222.32 1,161.20 1,335.38 21146 1,396.77 1,326.93 1,525.97 # 21034 1,079.95 1,025.95 1,179.84 21147 1,518.00 1,442.10 1,658.42 21040 448.77 426.33 490.28 21150 1,610.15 1,529.64 1,759.09 # 21040 363.50 345.33 397.13 21151 1,725.36 1,639.09 1,884.95 21044 804.29 764.08 878.69 21154 1,934.03 1,837.33 2,112.93 21045 1,114.96 1,059.21 1,218.09 21155 2,188.34 2,078.92 2,390.76 21046 987.24 937.88 1,078.56 21159 2,536.67 2,409.84 2,771.32 21047 1,196.89 1,137.05 1,307.61 21160 2,705.89 2,570.60 2,956.19 21048 1,004.75 954.51 1,097.69 21172 1,587.09 1,507.74 1,733.90 21049 1,151.70 1,094.12 1,258.24 21175 1,876.25 1,782.44 2,049.81 21050 780.31 741.29 852.48 21179 1,338.78 1,271.84 1,462.62 21060 719.64 683.66 786.21 21180 1,514.88 1,439.14 1,655.01 21070 587.01 557.66 641.31 21181 663.09 629.94 724.43 21073 343.97 326.77 375.79 21182 1,855.78 1,762.99 2,027.44 # 21073 215.67 204.89 235.62 21183 2,115.02 2,009.27 2,310.66 21076 910.71 865.17 994.95 21184 2,193.66 2,083.98 2,396.58 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 31140 PAGE 10 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 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 1,511.54 1,435.96 1,651.35 21344 1,375.20 1,306.44 1,502.41 21193 1,135.93 1,079.13 1,241.00 21345 730.79 694.25 798.39 21194 1,297.43 1,232.56 1,417.44 # 21345 598.07 568.17 653.40 21195 1,238.49 1,176.57 1,353.06 21346 873.79 830.10 954.62 21196 1,340.89 1,273.85 1,464.93 21347 1,048.79 996.35 1,145.80 21198 1,052.24 999.63 1,149.57 21348 1,091.38 1,036.81 1,192.33 21199 930.90 884.36 1,017.01 21355 398.09 378.19 434.92 21206 1,024.43 973.21 1,119.19 # 21355 289.49 275.02 316.27 21208 1,519.46 1,443.49 1,660.01 21356 453.44 430.77 495.39 # 21208 756.89 719.05 826.91 # 21356 342.84 325.70 374.56 21209 740.08 703.08 808.54 21360 483.32 459.15 528.02 # 21209 588.45 559.03 642.88 21365 1,000.09 950.09 1,092.60 21210 1,791.58 1,702.00 1,957.30 21366 1,122.43 1,066.31 1,226.26 # 21210 758.33 720.41 828.47 21385 653.00 620.35 713.40 21215 3,014.92 2,864.17 3,293.80 21386 605.95 575.65 662.00 # 21215 788.75 749.31 861.71 21387 694.18 659.47 758.39 21230 707.57 672.19 773.02 21390 693.71 659.02 757.87 21235 663.12 629.96 724.45 21395 877.89 834.00 959.10 # 21235 515.11 489.35 562.75 21400 159.32 151.35 174.05 21240 1,019.43 968.46 1,113.73 # 21400 129.55 123.07 141.53 21242 939.92 892.92 1,026.86 21401 432.06 410.46 472.03 21243 1,525.76 1,449.47 1,666.89 # 21401 261.13 248.07 285.28 21244 956.22 908.41 1,044.67 21406 493.48 468.81 539.13 21245 1,039.21 987.25 1,135.34 21407 580.78 551.74 634.50 # 21245 835.30 793.54 912.57 21408 791.39 751.82 864.59 21246 795.49 755.72 869.08 21421 652.01 619.41 712.32 21247 1,485.41 1,411.14 1,622.81 # 21421 565.94 537.64 618.29 21248 958.77 910.83 1,047.45 21422 619.07 588.12 676.34 # 21248 801.11 761.05 875.21 21423 728.98 692.53 796.41 21249 1,340.38 1,273.36 1,464.36 21431 688.32 653.90 751.99 # 21249 1,136.06 1,079.26 1,241.15 21432 614.50 583.78 671.35 21255 1,277.54 1,213.66 1,395.71 21433 1,524.23 1,448.02 1,665.22 21256 1,054.92 1,002.17 1,152.50 21435 1,202.84 1,142.70 1,314.11 21260 1,140.14 1,083.13 1,245.60 21436 1,719.59 1,633.61 1,878.65 21261 2,008.13 1,907.72 2,193.88 21440 465.51 442.23 508.56 21263 1,767.42 1,679.05 1,930.91 # 21440 393.92 374.22 430.35 21267 1,452.78 1,380.14 1,587.16 21445 666.10 632.80 727.72 21268 1,663.62 1,580.44 1,817.51 # 21445 561.53 533.45 613.47 21270 831.45 789.88 908.36 21450 487.98 463.58 533.12 # 21270 637.19 605.33 696.13 # 21450 421.62 400.54 460.62 21275 732.74 696.10 800.52 21451 648.95 616.50 708.98 21280 476.59 452.76 520.67 # 21451 563.28 535.12 615.39 21282 318.87 302.93 348.37 21452 588.35 558.93 642.77 21295 160.95 152.90 175.84 # 21452 298.77 283.83 326.40 21296 373.78 355.09 408.35 21453 748.19 710.78 817.40 21310 106.84 101.50 116.73 # 21453 684.65 650.42 747.98 # 21310 26.00 24.70 28.41 21454 503.13 477.97 549.67 21315 243.78 231.59 266.33 21461 1,661.39 1,578.32 1,815.07 # 21315 137.20 130.34 149.89 # 21461 842.51 800.38 920.44 21320 232.55 220.92 254.06 21462 1,814.82 1,724.08 1,982.69 # 21320 127.17 120.81 138.93 # 21462 919.93 873.93 1,005.02 21325 458.51 435.58 500.92 21465 831.92 790.32 908.87 21330 554.00 526.30 605.25 21470 1,076.22 1,022.41 1,175.77 21335 682.93 648.78 746.10 21480 88.52 84.09 96.70 21336 602.57 572.44 658.31 # 21480 29.40 27.93 32.12 21337 363.79 345.60 397.44 21485 575.51 546.73 628.74 # 21337 260.42 247.40 284.51 # 21485 504.32 479.10 550.97 21338 729.84 693.35 797.35 21490 835.11 793.35 912.35 21339 784.02 744.82 856.54 21495 612.49 581.87 669.15 21340 725.46 689.19 792.57 21497 578.29 549.38 631.79 21343 1,080.94 1,026.89 1,180.92 # 21497 504.29 479.08 550.94 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 99 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 402.20 382.09 439.40 22310 253.36 240.69 276.79 # 21501 288.78 274.34 315.49 # 22310 234.46 222.74 256.15 21502 479.38 455.41 523.72 22315 773.49 734.82 845.04 21510 434.88 413.14 475.11 # 22315 676.97 643.12 739.59 21550 233.72 222.03 255.33 22318 1,425.43 1,354.16 1,557.28 # 21550 144.44 137.22 157.80 22319 1,562.32 1,484.20 1,706.83 21555 389.19 369.73 425.19 22325 1,243.91 1,181.71 1,358.97 # 21555 295.08 280.33 322.38 22326 1,301.76 1,236.67 1,422.17 21556 371.64 353.06 406.02 22327 1,286.51 1,222.18 1,405.51 21557 525.84 499.55 574.48 22328 258.87 245.93 282.82 21600 500.44 475.42 546.73 22505 113.00 107.35 123.45 21610 964.28 916.07 1,053.48 22520 2,473.83 2,350.14 2,702.66 21615 621.77 590.68 679.28 # 22520 546.09 518.79 596.61 21616 760.98 722.93 831.37 22521 2,360.48 2,242.46 2,578.83 21620 481.66 457.58 526.22 # 22521 515.99 490.19 563.72 21627 505.53 480.25 552.29 22522 229.11 217.65 250.30 21630 1,151.02 1,093.47 1,257.49 22523 565.34 537.07 617.63 21632 1,136.20 1,079.39 1,241.30 22524 541.78 514.69 591.89 21685 905.27 860.01 989.01 22525 250.55 238.02 273.72 21700 396.06 376.26 432.70 22526 2,112.68 2,007.05 2,308.11 21705 566.57 538.24 618.98 # 22526 315.65 299.87 344.85 21720 347.60 330.22 379.75 22527 1,741.29 1,654.23 1,902.36 21725 482.09 457.99 526.69 # 22527 144.56 137.33 157.93 21740 983.35 934.18 1,074.31 22532 1,552.36 1,474.74 1,695.95 21750 652.57 619.94 712.93 22533 1,454.02 1,381.32 1,588.52 21800 89.45 84.98 97.73 22534 339.29 322.33 370.68 # 21800 90.66 86.13 99.05 22548 1,661.11 1,578.05 1,814.76 21805 234.22 222.51 255.89 22554 1,162.79 1,104.65 1,270.35 21810 464.21 441.00 507.15 22556 1,489.37 1,414.90 1,627.14 21820 121.57 115.49 132.81 22558 1,361.61 1,293.53 1,487.56 21825 522.20 496.09 570.50 22585 314.32 298.60 343.39 21920 228.82 217.38 249.99 22590 1,375.30 1,306.54 1,502.52 # 21920 141.14 134.08 154.19 22595 1,309.66 1,244.18 1,430.81 21925 379.46 360.49 414.56 22600 1,121.59 1,065.51 1,225.34 # 21925 300.63 285.60 328.44 22610 1,109.32 1,053.85 1,211.93 21930 423.49 402.32 462.67 22612 1,434.98 1,363.23 1,567.71 # 21930 331.38 314.81 362.03 22614 367.04 348.69 400.99 21935 1,044.42 992.20 1,141.03 22630 1,379.75 1,310.76 1,507.37 22010 813.29 772.63 888.52 22632 298.15 283.24 325.73 22015 807.76 767.37 882.48 22800 1,224.24 1,163.03 1,337.48 22100 732.95 696.30 800.75 22802 1,942.64 1,845.51 2,122.34 22101 732.89 696.25 800.69 22804 2,250.24 2,137.73 2,458.39 22102 735.39 698.62 803.41 22808 1,652.39 1,569.77 1,805.24 22103 131.86 125.27 144.06 22810 1,850.64 1,758.11 2,021.83 22110 900.90 855.86 984.24 22812 2,029.61 1,928.13 2,217.35 22112 897.80 852.91 980.85 22818 2,024.58 1,923.35 2,211.85 22114 899.66 854.68 982.88 22819 2,291.49 2,176.92 2,503.46 22116 131.74 125.15 143.92 22830 733.46 696.79 801.31 22206 2,113.10 2,007.45 2,308.57 22840 717.25 681.39 783.60 22207 2,087.53 1,983.15 2,280.62 22842 717.84 681.95 784.24 22208 526.39 500.07 575.08 22843 759.66 721.68 829.93 22210 1,583.50 1,504.33 1,729.98 22844 936.49 889.67 1,023.12 22212 1,312.38 1,246.76 1,433.77 22845 684.52 650.29 747.83 22214 1,326.24 1,259.93 1,448.92 22846 711.51 675.93 777.32 22216 344.61 327.38 376.49 22847 783.41 744.24 855.88 22220 1,431.94 1,360.34 1,564.39 22848 340.90 323.86 372.44 22222 1,305.39 1,240.12 1,426.14 22849 1,178.92 1,119.97 1,287.97 22224 1,418.25 1,347.34 1,549.44 22850 648.05 615.65 708.00 22226 343.00 325.85 374.73 22851 380.91 361.86 416.14 22305 169.29 160.83 184.95 22852 620.64 589.61 678.05 # 22305 154.41 146.69 168.69 22855 997.00 947.15 1,089.22 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 99 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 1,591.39 1,511.82 1,738.59 23412 876.77 832.93 957.87 22862 1,871.95 1,778.35 2,045.10 23415 676.18 642.37 738.73 22865 1,823.61 1,732.43 1,992.29 23420 967.70 919.32 1,057.22 22900 361.79 343.70 395.26 23430 680.68 646.65 743.65 23000 495.05 470.30 540.85 23440 702.18 667.07 767.13 # 23000 328.95 312.50 359.38 23450 877.76 833.87 958.95 23020 631.73 600.14 690.16 23455 933.77 887.08 1,020.14 23030 405.08 384.83 442.55 23460 1,011.22 960.66 1,104.76 # 23030 236.56 224.73 258.44 23462 988.74 939.30 1,080.20 23031 393.49 373.82 429.89 23465 1,028.53 977.10 1,123.67 # 23031 203.65 193.47 222.49 23466 1,014.65 963.92 1,108.51 23035 636.81 604.97 695.72 23470 1,121.73 1,065.64 1,225.49 23040 657.88 624.99 718.74 23472 1,381.76 1,312.67 1,509.57 23044 523.21 497.05 571.61 23480 756.29 718.48 826.25 23065 191.32 181.75 209.01 23485 886.11 841.80 968.07 # 23065 149.49 142.02 163.32 23490 752.94 715.29 822.58 23066 468.00 444.60 511.29 23491 936.90 890.06 1,023.57 # 23066 310.34 294.82 339.04 23500 190.36 180.84 207.97 23075 237.53 225.65 259.50 # 23500 184.72 175.48 201.80 # 23075 159.90 151.91 174.70 23505 310.24 294.73 338.94 23076 508.42 483.00 555.45 # 23505 290.93 276.38 317.84 23077 1,066.07 1,012.77 1,164.69 23515 625.39 594.12 683.24 23100 445.06 422.81 486.23 23520 196.02 186.22 214.15 23101 412.10 391.50 450.23 # 23520 195.21 185.45 213.27 23105 582.42 553.30 636.30 23525 309.95 294.45 338.62 23106 438.33 416.41 478.87 # 23525 287.42 273.05 314.01 23107 606.39 576.07 662.48 23530 503.93 478.73 550.54 23120 514.13 488.42 561.68 23532 567.83 539.44 620.36 23125 641.26 609.20 700.58 23540 195.50 185.73 213.59 23130 554.98 527.23 606.31 # 23540 186.65 177.32 203.92 23140 466.64 443.31 509.81 23545 280.12 266.11 306.03 23145 629.66 598.18 687.91 # 23545 253.57 240.89 277.02 23146 563.69 535.51 615.84 23550 522.64 496.51 570.99 23150 593.78 564.09 648.70 23552 602.14 572.03 657.83 23155 719.08 683.13 785.60 23570 202.42 192.30 221.15 23156 615.09 584.34 671.99 # 23570 202.82 192.68 221.58 23170 488.37 463.95 533.54 23575 344.11 326.90 375.94 23172 504.85 479.61 551.55 # 23575 322.39 306.27 352.21 23174 686.79 652.45 750.32 23585 837.36 795.49 914.81 23180 644.37 612.15 703.97 23600 286.19 271.88 312.66 23182 620.45 589.43 677.84 # 23600 257.64 244.76 281.47 23184 695.40 660.63 759.72 23605 419.19 398.23 457.96 23190 507.65 482.27 554.61 # 23605 382.19 363.08 417.54 23195 682.05 647.95 745.14 23615 788.21 748.80 861.12 23200 793.80 754.11 867.23 23616 1,198.47 1,138.55 1,309.33 23210 831.79 790.20 908.73 23620 234.06 222.36 255.71 23220 980.85 931.81 1,071.58 # 23620 216.36 205.54 236.37 23221 1,144.86 1,087.62 1,250.76 23625 339.43 322.46 370.83 23222 1,540.51 1,463.48 1,683.00 # 23625 315.70 299.92 344.91 23330 210.65 200.12 230.14 23630 663.14 629.98 724.48 # 23330 137.45 130.58 150.17 23650 265.43 252.16 289.98 23331 538.37 511.45 588.17 # 23650 235.67 223.89 257.47 23332 809.99 769.49 884.91 23655 340.84 323.80 372.37 23350 159.88 151.89 174.67 23660 529.13 502.67 578.07 # 23350 48.87 46.43 53.39 23665 375.28 356.52 410.00 23395 1,173.12 1,114.46 1,281.63 # 23665 351.15 333.59 383.63 23397 1,048.76 996.32 1,145.77 23670 738.90 701.96 807.25 23400 893.68 849.00 976.35 23675 492.12 467.51 537.64 23405 577.81 548.92 631.26 # 23675 452.31 429.69 494.14 23406 720.47 684.45 787.12 23680 809.86 769.37 884.78 23410 824.78 783.54 901.07 23700 178.59 169.66 195.11 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 CALIFORNIA - MEDICARE CARRIER 31140 PAGE 13 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 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 937.55 890.67 1,024.27 24342 721.05 685.00 787.75 23802 1,109.45 1,053.98 1,212.08 24343 642.76 610.62 702.21 23900 1,216.85 1,156.01 1,329.41 24344 994.69 944.96 1,086.70 23920 986.50 937.18 1,077.76 24345 639.38 607.41 698.52 23921 408.19 387.78 445.95 24346 991.96 942.36 1,083.71 23930 337.73 320.84 368.97 24357 407.64 387.26 445.35 # 23930 196.96 187.11 215.18 24358 477.21 453.35 521.35 23931 274.47 260.75 299.86 24359 582.57 553.44 636.46 # 23931 146.57 139.24 160.13 24360 821.09 780.04 897.05 23935 458.68 435.75 501.11 24361 923.91 877.71 1,009.37 24000 429.86 408.37 469.63 24362 893.15 848.49 975.76 24006 649.85 617.36 709.96 24363 1,352.79 1,285.15 1,477.92 24065 223.07 211.92 243.71 24365 586.36 557.04 640.60 # 24065 148.66 141.23 162.41 24366 628.01 596.61 686.10 24066 543.19 516.03 593.43 24400 753.39 715.72 823.08 # 24066 358.98 341.03 392.18 24410 960.77 912.73 1,049.64 24075 439.77 417.78 480.45 24420 894.65 849.92 977.41 # 24075 281.31 267.24 307.33 24430 944.25 897.04 1,031.60 24076 427.56 406.18 467.11 24435 969.16 920.70 1,058.81 24077 738.86 701.92 807.21 24470 602.43 572.31 658.16 24100 362.25 344.14 395.76 24495 613.73 583.04 670.50 24101 454.71 431.97 496.77 24498 801.41 761.34 875.54 24102 562.49 534.37 614.53 24500 310.32 294.80 339.02 24105 307.94 292.54 336.42 # 24500 274.12 260.41 299.47 24110 530.65 504.12 579.74 24505 448.85 426.41 490.37 24115 610.53 580.00 667.00 # 24505 405.41 385.14 442.91 24116 795.64 755.86 869.24 24515 803.98 763.78 878.35 24120 476.45 452.63 520.52 24516 793.76 754.07 867.18 24125 540.91 513.86 590.94 24530 334.09 317.39 365.00 24126 577.51 548.63 630.92 # 24530 295.88 281.09 323.25 24130 462.79 439.65 505.60 24535 558.41 530.49 610.06 24134 697.50 662.63 762.02 # 24535 514.57 488.84 562.17 24136 574.73 545.99 627.89 24538 684.59 650.36 747.91 24138 601.04 570.99 656.64 24545 819.59 778.61 895.40 24140 670.12 636.61 732.10 24546 974.66 925.93 1,064.82 24145 565.73 537.44 618.06 24560 280.60 266.57 306.56 24147 590.28 560.77 644.89 # 24560 240.79 228.75 263.06 24149 1,044.93 992.68 1,141.58 24565 465.66 442.38 508.74 24150 890.84 846.30 973.25 # 24565 425.84 404.55 465.23 24151 1,032.60 980.97 1,128.12 24566 631.39 599.82 689.79 24152 661.22 628.16 722.38 24575 676.23 642.42 738.78 24153 624.01 592.81 681.73 24576 295.05 280.30 322.35 24155 768.99 730.54 840.12 # 24576 259.66 246.68 283.68 24160 553.75 526.06 604.97 24577 482.25 458.14 526.86 24164 453.66 430.98 495.63 # 24577 441.23 419.17 482.05 24200 188.92 179.47 206.39 24579 762.91 724.76 833.47 # 24200 124.97 118.72 136.53 24582 717.70 681.82 784.09 24201 527.44 501.07 576.23 24586 1,005.58 955.30 1,098.60 # 24201 331.97 315.37 362.68 24587 998.64 948.71 1,091.02 24220 172.73 164.09 188.70 24600 332.03 315.43 362.74 # 24220 64.14 60.93 70.07 # 24600 293.01 278.36 320.11 24300 364.89 346.65 398.65 24605 413.85 393.16 452.13 24301 688.47 654.05 752.16 24615 656.12 623.31 716.81 24305 530.25 503.74 579.30 24620 500.87 475.83 547.20 24310 434.37 412.65 474.55 24635 761.83 723.74 832.30 24320 697.64 662.76 762.17 24640 111.91 106.31 122.26 24330 657.40 624.53 718.21 # 24640 76.51 72.68 83.58 24331 723.39 687.22 790.30 24650 228.03 216.63 249.12 24332 547.44 520.07 598.08 # 24650 198.67 188.74 217.05 24340 561.92 533.82 613.89 24655 392.42 372.80 428.72 24341 655.54 622.76 716.17 # 24655 353.41 335.74 386.10 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 14 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 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 593.67 563.99 648.59 25250 477.99 454.09 522.20 24666 670.24 636.73 732.24 25251 652.78 620.14 713.16 24670 255.39 242.62 279.01 25259 364.17 345.96 397.85 # 24670 222.81 211.67 243.42 25260 691.46 656.89 755.42 24675 410.26 389.75 448.21 25263 684.76 650.52 748.10 # 24675 373.26 354.60 407.79 25265 802.61 762.48 876.85 24685 596.34 566.52 651.50 25270 569.62 541.14 622.31 24800 734.35 697.63 802.27 25272 634.12 602.41 692.77 24802 906.93 861.58 990.82 25274 733.05 696.40 800.86 24900 647.07 614.72 706.93 25275 612.39 581.77 669.04 24920 638.18 606.27 697.21 25280 637.93 606.03 696.93 24925 492.32 467.70 537.86 25290 592.21 562.60 646.99 24930 672.90 639.26 735.15 25295 598.48 568.56 653.84 24931 712.95 677.30 778.90 25300 634.41 602.69 693.09 24935 974.08 925.38 1,064.19 25301 604.04 573.84 659.92 25000 347.89 330.50 380.08 25310 689.74 655.25 753.54 25001 302.05 286.95 329.99 25312 777.06 738.21 848.94 25020 556.41 528.59 607.88 25315 827.61 786.23 904.16 25023 1,040.29 988.28 1,136.52 25316 957.20 909.34 1,045.74 25024 684.25 650.04 747.55 25320 884.47 840.25 966.29 25025 1,040.19 988.18 1,136.41 25332 773.87 735.18 845.46 25028 487.45 463.08 532.54 25335 894.38 849.66 977.11 25031 386.01 366.71 421.72 25337 821.67 780.59 897.68 25035 671.12 637.56 733.19 25350 747.28 709.92 816.41 25040 533.61 506.93 582.97 25355 823.27 782.11 899.43 25065 223.54 212.36 244.21 25360 729.76 693.27 797.26 # 25065 149.53 142.05 163.36 25365 963.06 914.91 1,052.15 25066 375.79 357.00 410.55 25370 1,030.66 979.13 1,126.00 25075 326.01 309.71 356.17 25375 1,006.50 956.18 1,099.61 25076 460.56 437.53 503.16 25390 832.88 791.24 909.93 25077 736.34 699.52 804.45 25391 1,038.68 986.75 1,134.76 25085 444.16 421.95 485.24 25392 1,039.14 987.18 1,135.26 25100 329.53 313.05 360.01 25393 1,167.67 1,109.29 1,275.68 25101 383.97 364.77 419.49 25394 702.12 667.01 767.06 25105 468.60 445.17 511.95 25400 872.87 829.23 953.61 25107 570.24 541.73 622.99 25405 1,085.59 1,031.31 1,186.01 25109 464.06 440.86 506.99 25415 1,023.22 972.06 1,117.87 25110 363.60 345.42 397.23 25420 1,201.09 1,141.04 1,312.20 25111 296.32 281.50 323.73 25425 1,110.06 1,054.56 1,212.74 25112 359.29 341.33 392.53 25426 1,130.37 1,073.85 1,234.93 25115 795.64 755.86 869.24 25430 643.17 611.01 702.66 25116 665.03 631.78 726.55 25431 722.24 686.13 789.05 25118 364.70 346.47 398.44 25440 723.84 687.65 790.80 25119 483.73 459.