1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 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 37.00 35.15 40.42 G0270 25.17 23.91 27.50 G0102 21.22 20.16 23.18 # G0270 24.75 23.51 27.04 # G0102 8.58 8.15 9.37 G0271 14.21 13.50 15.53 G0104 136.10 129.30 148.70 # G0271 13.79 13.10 15.07 # G0104 58.59 55.66 64.01 G0275 13.79 13.10 15.07 G0105 397.76 377.87 434.55 G0278 13.79 13.10 15.07 # G0105 203.15 192.99 221.94 G0281 11.49 10.92 12.56 G0105 53 136.10 129.30 148.70 G0283 11.49 10.92 12.56 # G0105 53 58.59 55.66 64.01 G0288 250.98 238.43 274.19 G0106 196.43 186.61 214.60 G0289 86.72 82.38 94.74 G0106 TC 147.96 140.56 161.64 G0308 740.31 703.29 808.78 G0106 26 48.47 46.05 52.96 G0309 606.17 575.86 662.24 G0108 30.21 28.70 33.01 G0310 473.88 450.19 517.72 G0109 17.15 16.29 18.73 G0311 512.85 487.21 560.29 G0117 46.81 44.47 51.14 G0312 421.97 400.87 461.00 G0118 32.17 30.56 35.14 G0313 330.87 314.33 361.48 C G0120 192.64 183.01 210.46 G0314 451.98 429.38 493.79 C G0120 TC 144.17 136.96 157.50 G0315 371.51 352.93 405.87 G0120 26 48.47 46.05 52.96 G0316 288.38 273.96 315.05 G0121 397.76 377.87 434.55 G0317 284.76 270.52 311.10 # G0121 203.15 192.99 221.94 G0318 233.19 221.53 254.76 G0121 53 136.10 129.30 148.70 G0319 182.00 172.90 198.84 # G0121 53 58.59 55.66 64.01 G0320 575.42 546.65 628.65 G0124 25.74 24.45 28.12 G0321 406.80 386.46 444.43 G0127 19.53 18.55 21.33 G0322 353.40 335.73 386.09 # G0127 8.58 8.15 9.37 G0323 221.39 210.32 241.87 G0128 3.83 3.64 4.19 G0324 20.61 19.58 22.52 G0130 39.42 37.45 43.07 G0325 12.18 11.57 13.31 G0130 TC 28.88 27.44 31.56 G0326 14.14 13.43 15.44 G0130 26 10.54 10.01 11.51 G0327 7.85 7.46 8.58 G0141 25.74 24.45 28.12 G0329 8.54 8.11 9.33 G0166 172.78 164.14 188.76 G0332 82.98 78.83 90.65 G0168 90.38 85.86 98.74 G0339 3,915.07 3,719.32 4,277.22 # G0168 25.09 23.84 27.42 G0340 2,658.17 2,525.26 2,904.05 G0179 47.53 45.15 51.92 G0341 354.73 336.99 387.54 G0180 61.86 58.77 67.59 G0342 664.68 631.45 726.17 G0181 108.42 103.00 118.45 G0343 1,097.26 1,042.40 1,198.76 G0182 112.63 107.00 123.05 G0344 95.43 90.66 104.26 G0202 144.30 137.09 157.65 # G0344 67.21 63.85 73.43 G0202 TC 109.94 104.44 120.11 G0364 12.89 12.25 14.09 G0202 26 34.37 32.65 37.55 # G0364 9.10 8.65 9.95 G0204 162.99 154.84 178.07 C G0365 177.75 168.86 194.19 G0204 TC 120.05 114.05 131.16 C G0365 TC 165.35 157.08 180.64 G0204 26 42.95 40.80 46.92 G0365 26 12.41 11.79 13.56 G0206 130.10 123.60 142.14 G0366 24.34 23.12 26.59 G0206 TC 95.74 90.95 104.59 G0367 15.76 14.97 17.22 G0206 26 34.37 32.65 37.55 G0368 8.58 8.15 9.37 G0237 14.92 14.17 16.30 G0372 15.32 14.55 16.73 G0238 15.76 14.97 17.22 # G0372 8.16 7.75 8.91 G0239 14.08 13.38 15.39 G0389 124.38 118.16 135.88 G0245 64.85 61.61 70.85 G0389 TC 95.49 90.72 104.33 # G0245 43.37 41.20 47.38 G0389 26 28.88 27.44 31.56 G0246 39.11 37.15 42.72 G0392 2,546.57 2,419.24 2,782.13 # G0246 22.26 21.15 24.32 # G0392 485.01 460.76 529.87 G0247 42.75 40.61 46.70 G0393 1,939.26 1,842.30 2,118.65 # G0247 25.06 23.81 27.38 # G0393 310.31 294.79 339.01 G0248 211.34 200.77 230.89 G0396 30.16 28.65 32.95 G0249 155.32 147.55 169.68 # G0396 28.48 27.06 31.12 G0250 9.39 8.92 10.26 G0397 58.94 55.99 64.39 G0268 48.69 46.26 53.20 # G0397 56.84 54.00 62.10 # G0268 30.58 29.05 33.41 G9041 23.68 22.50 25.88 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 2 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G9042 10.49 9.97 11.47 10121 249.41 236.94 272.48 G9043 10.49 9.97 11.47 # 10121 174.01 165.31 190.11 G9044 9.23 8.77 10.09 10140 142.95 135.80 156.17 M0064 39.07 37.12 42.69 # 10140 112.20 106.59 122.58 # M0064 16.75 15.91 18.30 10160 117.69 111.81 128.58 P3001 25.74 24.45 28.12 # 10160 90.73 86.19 99.12 Q0035 22.24 21.13 24.30 10180 218.63 207.70 238.86 Q0035 TC 14.08 13.38 15.39 # 10180 166.81 158.47 182.24 Q0035 26 8.16 7.75 8.91 11000 49.81 47.32 54.42 Q0091 43.16 41.00 47.15 # 11000 30.43 28.91 33.25 # Q0091 18.31 17.39 20.00 11001 20.86 19.82 22.79 Q0092 17.15 16.29 18.73 # 11001 15.38 14.61 16.80 R0070 157.76 149.87 172.35 11004 534.37 507.65 583.80 R0075 157.76 149.87 172.35 11005 706.45 671.13 771.80 0067T 641.18 609.12 700.49 11006 666.31 632.99 727.94 C 0067T TC 207.02 196.67 226.17 11008 256.97 244.12 280.74 0067T 26 130.28 123.77 142.34 11010 449.44 426.97 491.02 0073T 661.03 627.98 722.18 # 11010 265.78 252.49 290.36 0075T 1,139.56 1,082.58 1,244.97 11011 509.16 483.70 556.26 0076T 376.05 357.25 410.84 # 11011 280.85 266.81 306.83 0078T 1,284.35 1,220.13 1,403.15 11012 711.64 676.06 777.47 0079T 1,183.11 1,123.95 1,292.54 # 11012 412.98 392.33 451.18 0080T 228.82 217.38 249.99 11040 43.95 41.75 48.01 0081T 228.82 217.38 249.99 # 11040 26.26 24.95 28.69 0145T 636.92 605.07 695.83 11041 52.39 49.77 57.24 C 0145T TC 323.44 307.27 353.36 # 11041 34.28 32.57 37.46 0145T 26 102.92 97.77 112.44 11042 71.18 67.62 77.76 0146T 636.92 605.07 695.83 # 11042 45.07 42.82 49.24 C 0146T TC 323.44 307.27 353.36 11043 257.29 244.43 281.09 0146T 26 102.92 97.77 112.44 # 11043 221.90 210.81 242.43 0147T 636.92 605.07 695.83 11044 347.61 330.23 379.76 C 0147T TC 323.44 307.27 353.36 # 11044 306.32 291.00 334.65 0147T 26 102.92 97.77 112.44 11055 44.72 42.48 48.85 0148T 636.92 605.07 695.83 # 11055 21.97 20.87 24.00 C 0148T TC 323.44 307.27 353.36 11056 54.82 52.08 59.89 0148T 26 102.92 97.77 112.44 # 11056 30.81 29.27 33.66 0149T 636.92 605.07 695.83 11057 66.07 62.77 72.19 C 0149T TC 323.44 307.27 353.36 # 11057 40.38 38.36 44.11 0149T 26 102.92 97.77 112.44 11100 93.84 89.15 102.52 0150T 636.92 605.07 695.83 # 11100 44.14 41.93 48.22 C 0150T TC 323.44 307.27 353.36 11101 29.99 28.49 32.76 0150T 26 102.92 97.77 112.44 # 11101 22.41 21.29 24.48 0151T 205.06 194.81 224.03 11200 75.65 71.87 82.65 C 0151T TC 109.08 103.63 119.17 # 11200 63.01 59.86 68.84 0151T 26 67.72 64.33 73.98 11201 17.31 16.44 18.91 10021 137.36 130.49 150.06 # 11201 15.63 14.85 17.08 # 10021 65.33 62.06 71.37 11300 64.07 60.87 70.00 10022 144.35 137.13 157.70 # 11300 27.00 25.65 29.50 # 10022 62.62 59.49 68.41 11301 85.15 80.89 93.02 10040 91.06 86.51 99.49 # 11301 45.97 43.67 50.22 # 10040 78.84 74.90 86.14 11302 101.23 96.17 110.60 10060 101.16 96.10 110.52 # 11302 56.58 53.75 61.81 # 10060 86.41 82.09 94.40 11303 120.15 114.14 131.26 10061 171.63 163.05 187.51 # 11303 66.65 63.32 72.82 # 10061 152.67 145.04 166.80 11305 65.17 61.91 71.20 10080 165.31 157.04 180.60 # 11305 34.84 33.10 38.07 # 10080 90.33 85.81 98.68 11306 88.54 84.11 96.73 10081 250.03 237.53 273.16 # 11306 52.32 49.70 57.16 # 10081 152.73 145.09 166.85 11307 103.22 98.06 112.77 10120 131.79 125.20 143.98 # 11307 60.67 57.64 66.29 # 10120 85.46 81.19 93.37 11308 118.01 112.11 128.93 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 3 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11308 74.20 70.49 81.06 11602 219.08 208.13 239.35 11310 78.40 74.48 85.65 # 11602 140.31 133.29 153.28 # 11310 39.23 37.27 42.86 11603 248.34 235.92 271.31 11311 97.02 92.17 106.00 # 11603 165.78 157.49 181.11 # 11311 57.00 54.15 62.27 11604 274.07 260.37 299.43 11312 112.80 107.16 123.23 # 11604 181.39 172.32 198.17 # 11312 65.62 62.34 71.69 11606 380.13 361.12 415.29 11313 142.09 134.99 155.24 # 11606 267.24 253.88 291.96 # 11313 88.17 83.76 96.32 11620 170.97 162.42 186.78 11400 113.05 107.40 123.51 # 11620 101.47 96.40 110.86 # 11400 69.66 66.18 76.11 11621 202.83 192.69 221.59 11401 134.49 127.77 146.94 # 11621 130.80 124.26 142.90 # 11401 91.10 86.55 99.53 11622 228.46 217.04 249.60 11402 149.15 141.69 162.94 # 11622 150.11 142.60 163.99 # 11402 99.86 94.87 109.10 11623 266.29 252.98 290.93 11403 170.55 162.02 186.32 # 11623 183.73 174.54 200.72 # 11403 126.74 120.40 138.46 11624 300.81 285.77 328.64 11404 193.59 183.91 211.50 # 11624 209.82 199.33 229.23 # 11404 140.09 133.09 153.05 11626 369.87 351.38 404.09 11406 265.96 252.66 290.56 # 11626 267.08 253.73 291.79 # 11406 205.73 195.44 224.76 11640 178.62 169.69 195.14 11420 112.27 106.66 122.66 # 11640 108.69 103.26 118.75 # 11420 75.62 71.84 82.62 11641 216.79 205.95 236.84 11421 142.75 135.61 155.95 # 11641 142.65 135.52 155.85 # 11421 100.63 95.60 109.94 11642 249.08 236.63 272.12 11422 159.40 151.43 174.14 # 11642 167.36 158.99 182.84 # 11422 120.65 114.62 131.81 11643 291.89 277.30 318.90 11423 185.43 176.16 202.58 # 11643 207.64 197.26 226.85 # 11423 139.94 132.94 152.88 11644 361.63 343.55 395.08 11424 212.08 201.48 231.70 # 11644 259.69 246.71 283.72 # 11424 161.53 153.45 176.47 11646 473.66 449.98 517.48 11426 298.85 283.91 326.50 # 11646 367.09 348.74 401.05 # 11426 242.82 230.68 265.28 11719 19.41 18.44 21.21 11440 125.38 119.11 136.98 # 11719 8.88 8.44 9.71 # 11440 92.10 87.50 100.63 11720 28.79 27.35 31.45 11441 153.94 146.24 168.18 # 11720 16.15 15.34 17.64 # 11441 118.55 112.62 129.51 11721 41.15 39.09 44.95 11442 172.58 163.95 188.54 # 11721 27.67 26.29 30.23 # 11442 131.30 124.74 143.45 11730 91.11 86.55 99.53 11443 206.61 196.28 225.72 # 11730 56.56 53.73 61.79 # 11443 161.54 153.46 176.48 11732 41.92 39.82 45.79 11444 258.84 245.90 282.79 # 11732 28.86 27.42 31.53 # 11444 205.76 195.47 224.79 11740 42.08 39.98 45.98 11446 344.65 327.42 376.53 # 11740 30.28 28.77 33.09 # 11446 288.21 273.80 314.87 11750 195.36 185.59 213.43 11450 330.42 313.90 360.99 # 11750 164.19 155.98 179.38 # 11450 209.95 199.45 229.37 11752 276.55 262.72 302.13 11451 436.17 414.36 476.51 # 11752 249.17 236.71 272.22 # 11451 277.78 263.89 303.47 11755 124.13 117.92 135.61 11462 328.05 311.65 358.40 # 11755 80.32 76.30 87.75 # 11462 202.52 192.39 221.25 11760 187.17 177.81 204.48 11463 444.47 422.25 485.59 # 11760 128.19 121.78 140.05 # 11463 281.45 267.38 307.49 11762 247.56 235.18 270.46 11470 357.48 339.61 390.55 # 11762 193.65 183.97 211.57 # 11470 238.69 226.76 260.77 11765 120.50 114.48 131.65 11471 458.45 435.53 500.86 # 11765 63.63 60.45 69.52 # 11471 301.74 286.65 329.65 11770 245.04 232.79 267.71 11600 169.62 161.14 185.31 # 11770 162.48 154.36 177.51 # 11600 100.54 95.51 109.84 11771 482.95 458.80 527.62 11601 201.19 191.13 219.80 # 11771 371.74 353.15 406.12 # 11601 129.16 122.70 141.11 11772 598.29 568.38 653.64 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 4 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11772 494.67 469.94 540.43 12031 208.51 198.08 227.79 11900 51.10 48.55 55.83 # 12031 136.06 129.26 148.65 # 11900 27.93 26.53 30.51 12032 279.61 265.63 305.47 11901 62.71 59.57 68.51 # 12032 174.72 165.98 190.88 # 11901 43.33 41.16 47.33 12034 271.11 257.55 296.18 11920 188.87 179.43 206.34 # 12034 179.28 170.32 195.87 # 11920 107.57 102.19 117.52 12035 349.05 331.60 381.34 11921 213.32 202.65 233.05 # 12035 217.63 206.75 237.76 # 11921 126.97 120.62 138.71 12036 384.63 365.40 420.21 11922 61.98 58.88 67.71 # 12036 254.47 241.75 278.01 # 11922 28.70 27.27 31.36 12037 432.23 410.62 472.21 11950 72.73 69.09 79.45 # 12037 295.75 280.96 323.10 # 11950 45.77 43.48 50.00 12041 221.46 210.39 241.95 11951 94.12 89.41 102.82 # 12041 147.32 139.95 160.94 # 11951 61.68 58.60 67.39 12042 261.74 248.65 285.95 11952 135.24 128.48 147.75 # 12042 173.70 165.02 189.77 # 11952 92.27 87.66 100.81 12044 296.27 281.46 323.68 11954 159.31 151.34 174.04 # 12044 189.28 179.82 206.79 # 11954 104.97 99.72 114.68 12045 352.34 334.72 384.93 11960 853.18 810.52 932.10 # 12045 226.81 215.47 247.79 11970 555.94 528.14 607.36 12046 416.13 395.32 454.62 11971 466.08 442.78 509.20 # 12046 266.17 252.86 290.79 # 11971 282.84 268.70 309.01 12047 445.07 422.82 486.24 11976 138.96 132.01 151.81 # 12047 295.53 280.75 322.86 # 11976 90.94 86.39 99.35 12051 245.43 233.16 268.13 11980 99.25 94.29 108.43 # 12051 161.18 153.12 176.09 # 11980 75.24 71.48 82.20 12052 270.01 256.51 294.99 11981 129.28 122.82 141.24 # 12052 184.08 174.88 201.11 # 11981 79.99 75.99 87.39 12053 295.11 280.35 322.40 11982 148.72 141.28 162.47 # 12053 190.22 180.71 207.82 # 11982 97.33 92.46 106.33 12054 315.91 300.11 345.13 11983 222.13 211.02 242.67 # 12054 203.86 193.67 222.72 # 11983 177.06 168.21 193.44 12055 384.60 365.37 420.18 12001 140.76 133.72 153.78 # 12055 252.33 239.71 275.67 # 12001 94.00 89.30 102.70 12056 475.43 451.66 519.41 12002 149.64 142.16 163.48 # 12056 313.67 297.99 342.69 # 12002 105.41 100.14 115.16 12057 511.29 485.73 558.59 12004 175.29 166.53 191.51 # 12057 359.22 341.26 392.45 # 12004 123.48 117.31 134.91 13100 292.64 278.01 319.71 12005 217.98 207.08 238.14 # 13100 214.71 203.97 234.57 # 12005 153.11 145.45 167.27 13101 363.76 345.57 397.41 12006 270.82 257.28 295.87 # 13101 259.71 246.72 283.73 # 12006 193.73 184.04 211.65 13102 98.78 93.84 107.92 12007 304.32 289.10 332.47 # 13102 68.87 65.43 75.24 # 12007 222.18 211.07 242.73 13120 303.45 288.28 331.52 12011 150.10 142.60 163.99 # 13120 223.41 212.24 244.08 # 12011 97.45 92.58 106.47 13121 398.25 378.34 435.09 12013 164.69 156.46 179.93 # 13121 290.41 275.89 317.27 # 12013 111.61 106.03 121.93 13122 113.86 108.17 124.40 12014 192.87 183.23 210.71 # 13122 78.48 74.56 85.74 # 12014 133.47 126.80 145.82 13131 333.84 317.15 364.72 12015 241.92 229.82 264.29 # 13131 253.38 240.71 276.82 # 12015 166.94 158.59 182.38 13132 519.25 493.29 567.28 12016 285.71 271.42 312.13 # 13132 420.68 399.65 459.60 # 12016 203.15 192.99 221.94 13133 153.98 146.28 168.22 12017 245.67 233.39 268.40 # 13133 121.54 115.46 132.78 12018 294.39 279.67 321.62 13150 341.26 324.20 372.83 12020 256.36 243.54 280.07 # 13150 254.48 241.76 278.02 # 12020 175.48 166.71 191.72 13151 377.38 358.51 412.29 12021 147.60 140.22 161.25 # 13151 293.98 279.28 321.17 # 12021 127.80 121.41 139.62 13152 512.03 486.43 559.39 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 5 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 13152 393.66 373.98 430.08 15151 121.81 115.72 133.08 13153 171.56 162.98 187.43 # 15151 107.91 102.51 117.89 # 13153 133.23 126.57 145.56 15152 149.63 142.15 163.47 13160 744.85 707.61 813.75 # 15152 134.89 128.15 147.37 14000 602.03 571.93 657.72 15155 696.94 662.09 761.40 # 14000 490.83 466.29 536.23 # 15155 650.61 618.08 710.79 14001 779.18 740.22 851.25 15156 160.47 152.45 175.32 # 14001 655.33 622.56 715.94 # 15156 149.52 142.04 163.35 14020 670.67 637.14 732.71 15157 178.66 169.73 195.19 # 14020 560.72 532.68 612.58 # 15157 163.07 154.92 178.16 14021 875.12 831.36 956.06 15170 383.74 364.55 419.23 # 14021 758.85 720.91 829.05 # 15170 323.08 306.93 352.97 14040 703.73 668.54 768.82 15171 84.82 80.58 92.67 # 14040 602.63 572.50 658.38 # 15171 80.60 76.57 88.06 14041 959.19 911.23 1,047.91 15175 503.10 477.95 549.64 # 14041 829.45 787.98 906.18 # 15175 444.97 422.72 486.13 14060 716.06 680.26 782.30 15176 136.61 129.78 149.25 # 14060 634.76 603.02 693.47 # 15176 129.03 122.58 140.97 14061 1,041.44 989.37 1,137.78 15200 739.29 702.33 807.68 # 14061 899.06 854.11 982.23 # 15200 596.91 567.06 652.12 14300 1,002.13 952.02 1,094.82 15201 146.65 139.32 160.22 # 14300 874.92 831.17 955.85 # 15201 72.93 69.28 79.67 14350 701.39 666.32 766.27 15220 707.73 672.34 773.19 15002 315.57 299.79 344.76 # 15220 575.46 546.69 628.69 # 15002 208.99 198.54 228.32 15221 136.06 129.26 148.65 15003 68.06 64.66 74.36 # 15221 67.39 64.02 73.62 # 15003 41.10 39.05 44.91 15240 838.88 796.94 916.48 15004 378.72 359.78 413.75 # 15240 725.56 689.28 792.67 # 15004 258.24 245.33 282.13 15241 174.68 165.95 190.84 15005 112.91 107.26 123.35 # 15241 106.02 100.72 115.83 # 15005 83.00 78.85 90.68 15260 894.85 850.11 977.63 15040 253.72 241.03 277.18 # 15260 782.80 743.66 855.21 # 15040 120.61 114.58 131.77 15261 201.10 191.05 219.71 15050 504.74 479.50 551.43 # 15261 135.39 128.62 147.91 # 15050 411.65 391.07 449.73 15300 311.41 295.84 340.22 15100 838.39 796.47 915.94 # 15300 263.81 250.62 288.21 # 15100 672.84 639.20 735.08 15301 57.32 54.45 62.62 15101 195.69 185.91 213.80 # 15301 53.11 50.45 58.02 # 15101 107.65 102.27 117.61 15320 354.27 336.56 387.04 15110 815.72 774.93 891.17 # 15320 301.62 286.54 329.52 # 15110 688.08 653.68 751.73 15321 85.99 81.69 93.94 15111 115.80 110.01 126.51 # 15321 80.09 76.09 87.50 # 15111 99.80 94.81 109.03 15330 290.00 275.50 316.83 15115 801.06 761.01 875.16 # 15330 241.14 229.08 263.44 # 15115 709.23 673.77 774.84 15331 57.75 54.86 63.09 15116 152.82 145.18 166.96 # 15331 53.95 51.25 58.94 # 15116 135.97 129.17 148.55 15335 311.59 296.01 340.41 15120 869.93 826.43 950.39 # 15335 262.30 249.19 286.57 # 15120 725.87 689.58 793.02 15336 84.23 80.02 92.02 15121 268.15 254.74 292.95 # 15336 77.07 73.22 84.20 # 15121 167.06 158.71 182.52 15340 301.00 285.95 328.84 15130 654.85 622.11 715.43 # 15340 252.98 240.33 276.38 # 15130 530.58 504.05 579.66 15341 44.79 42.55 48.93 15131 93.15 88.49 101.76 # 15341 25.84 24.55 28.23 # 15131 80.51 76.48 87.95 15360 341.89 324.80 373.52 15135 813.21 772.55 888.43 # 15360 285.02 270.77 311.39 # 15135 725.17 688.91 792.25 15361 65.68 62.40 71.76 15136 89.06 84.61 97.30 # 15361 59.36 56.39 64.85 # 15136 81.47 77.40 89.01 15365 340.58 323.55 372.08 15150 674.75 641.01 737.16 # 15365 288.77 274.33 315.48 # 15150 605.24 574.98 661.23 15366 82.83 78.69 90.49 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 6 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 15366 76.51 72.68 83.58 # 15786 126.64 120.31 138.36 15400 351.69 334.11 384.23 15787 52.76 50.12 57.64 # 15400 326.00 309.70 356.16 # 15787 17.38 16.51 18.99 15401 99.03 94.08 108.19 15788 414.65 393.92 453.01 # 15401 54.38 51.66 59.41 # 15788 225.52 214.24 246.38 15420 396.15 376.34 432.79 15789 540.69 513.66 590.71 # 15420 348.55 331.12 380.79 # 15789 395.78 375.99 432.39 15421 109.16 103.70 119.26 15792 405.48 385.21 442.99 # 15421 80.09 76.09 87.50 # 15792 257.20 244.34 280.99 15430 504.75 479.51 551.44 15793 437.86 415.97 478.37 # 15430 487.06 462.71 532.12 # 15793 330.02 313.52 360.55 15570 828.79 787.35 905.45 15819 673.85 640.16 736.18 # 15570 652.71 620.07 713.08 15820 498.95 474.00 545.10 15572 777.64 738.76 849.57 # 15820 444.19 421.98 485.28 # 15572 647.90 615.51 707.84 15821 531.43 504.86 580.59 15574 838.48 796.56 916.04 # 15821 469.92 446.42 513.38 # 15574 703.69 668.51 768.79 15822 396.30 376.49 432.96 15576 747.72 710.33 816.88 # 15822 344.07 326.87 375.90 # 15576 620.51 589.48 677.90 15823 610.20 579.69 666.64 15600 346.18 328.87 378.20 # 15823 553.33 525.66 604.51 # 15600 196.64 186.81 214.83 15830 1,072.19 1,018.58 1,171.37 15610 309.82 294.33 338.48 15832 827.07 785.72 903.58 # 15610 230.20 218.69 251.49 15833 770.80 732.26 842.10 15620 433.18 411.52 473.25 15834 786.55 747.22 859.30 # 15620 296.70 281.87 324.15 15835 804.18 763.97 878.57 15630 441.06 419.01 481.86 15836 678.73 644.79 741.51 # 15630 321.85 305.76 351.62 15837 714.90 679.16 781.03 15650 473.17 449.51 516.94 # 15837 628.96 597.51 687.14 # 15650 350.59 333.06 383.02 15838 532.71 506.07 581.98 15731 1,016.38 965.56 1,110.39 15839 776.96 738.11 848.83 # 15731 908.54 863.11 992.58 # 15839 656.06 623.26 716.75 15732 1,414.54 1,343.81 1,545.38 15840 936.24 889.43 1,022.84 # 15732 1,216.55 1,155.72 1,329.08 15841 1,545.11 1,467.85 1,688.03 15734 1,453.60 1,380.92 1,588.06 15842 2,444.84 2,322.60 2,670.99 # 15734 1,251.83 1,189.24 1,367.63 15845 870.71 827.17 951.25 15736 1,311.61 1,246.03 1,432.93 15851 94.55 89.82 103.29 # 15736 1,083.72 1,029.53 1,183.96 # 15851 42.32 40.20 46.23 15738 1,387.64 1,318.26 1,516.00 15852 44.06 41.86 48.14 # 15738 1,180.38 1,121.36 1,289.56 15860 103.97 98.77 113.59 15740 909.30 863.84 993.42 15920 536.13 509.32 585.72 # 15740 782.09 742.99 854.44 15922 691.00 656.45 754.92 15750 849.52 807.04 928.10 15931 610.99 580.44 667.51 15756 2,203.59 2,093.41 2,407.42 15933 756.45 718.63 826.42 15757 2,196.46 2,086.64 2,399.64 15934 842.77 800.63 920.72 15758 2,191.47 2,081.90 2,394.19 15935 999.87 949.88 1,092.36 15760 783.18 744.02 855.62 15936 822.77 781.63 898.87 # 15760 653.86 621.17 714.35 15937 963.82 915.63 1,052.97 15770 606.96 576.61 663.10 15940 632.94 601.29 691.48 15775 299.02 284.07 326.68 15941 839.80 797.81 917.48 # 15775 202.13 192.02 220.82 15944 816.26 775.45 891.77 15776 423.62 402.44 462.81 15945 902.58 857.45 986.07 # 15776 312.41 296.79 341.31 15946 1,490.33 1,415.81 1,628.18 15780 786.73 747.39 859.50 15950 526.39 500.07 575.08 # 15780 618.65 587.72 675.88 15951 750.26 712.75 819.66 15781 504.45 479.23 551.11 15952 778.52 739.59 850.53 # 15781 407.98 387.58 445.72 15953 869.25 825.79 949.66 15782 548.80 521.36 599.56 15956 1,054.87 1,002.13 1,152.45 # 15782 400.10 380.10 437.12 15958 1,078.97 1,025.02 1,178.77 15783 466.24 442.93 509.37 16000 65.59 62.31 71.66 # 15783 347.45 330.08 379.59 # 16000 42.84 40.70 46.81 15786 225.63 214.35 246.50 16020 79.79 75.80 87.17 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 7 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 16020 53.26 50.60 58.19 17311 667.75 634.36 729.51 16025 138.56 131.63 151.37 # 17311 345.08 327.83 377.00 # 16025 106.54 101.21 116.39 17312 405.74 385.45 443.27 16030 167.11 158.75 182.56 # 17312 183.75 174.56 200.74 # 16030 122.45 116.33 133.78 17313 610.71 580.17 667.20 16035 198.95 189.00 217.35 # 17313 309.95 294.45 338.62 16036 78.95 75.00 86.25 17314 375.10 356.35 409.80 17000 72.12 68.51 78.79 # 17314 169.95 161.45 185.67 # 17000 48.95 46.50 53.48 17315 78.45 74.53 85.71 17003 7.23 6.87 7.90 # 17315 48.54 46.11 53.03 # 17003 4.71 4.47 5.14 17340 42.36 40.24 46.28 17004 164.50 156.28 179.72 # 17340 42.78 40.64 46.74 # 17004 127.01 120.66 138.76 17360 120.01 114.01 131.11 17106 362.47 344.35 396.00 # 17360 90.10 85.60 98.44 # 17106 306.02 290.72 334.33 19000 112.92 107.27 123.36 17107 627.83 596.44 685.91 # 19000 43.00 40.85 46.98 # 17107 548.21 520.80 598.92 19001 25.92 24.62 28.31 17108 844.69 802.46 922.83 # 19001 21.29 20.23 23.26 # 17108 758.76 720.82 828.94 19020 412.64 392.01 450.81 17110 95.74 90.95 104.59 # 19020 260.15 247.14 284.21 # 17110 57.41 54.54 62.72 19030 171.16 162.60 186.99 17111 115.90 110.11 126.63 # 19030 76.38 72.56 83.44 # 17111 73.77 70.08 80.59 19100 135.37 128.60 147.89 17250 72.17 68.56 78.84 # 19100 63.34 60.17 69.20 # 17250 33.84 32.15 36.97 19101 306.88 291.54 335.27 17260 89.10 84.65 97.35 # 19101 197.78 187.89 216.07 # 17260 61.71 58.62 67.41 19102 225.45 214.18 246.31 17261 128.12 121.71 139.97 # 19102 99.92 94.92 109.16 # 17261 81.79 77.70 89.36 19103 588.58 559.15 643.02 17262 155.29 147.53 169.66 # 19103 184.61 175.38 201.69 # 17262 104.32 99.10 113.97 19105 2,092.84 1,988.20 2,286.43 17263 170.92 162.37 186.73 # 19105 175.77 166.98 192.03 # 17263 114.89 109.15 125.52 19110 413.78 393.09 452.05 17264 184.59 175.36 201.66 # 19110 289.51 275.03 316.28 # 17264 122.67 116.54 134.02 19112 399.25 379.29 436.18 17266 208.85 198.41 228.17 # 19112 262.77 249.63 287.07 # 17266 141.45 134.38 154.54 19120 421.64 400.56 460.64 17270 133.95 127.25 146.34 # 19120 354.24 336.53 387.01 # 17270 88.04 83.64 96.19 19125 464.21 441.00 507.15 17271 146.32 139.00 159.85 # 19125 392.60 372.97 428.92 # 17271 99.15 94.19 108.32 19126 146.99 139.64 160.59 17272 167.59 159.21 183.09 19260 1,107.25 1,051.89 1,209.67 # 17272 114.93 109.18 125.56 19271 1,529.04 1,452.59 1,670.48 17273 186.36 177.04 203.60 19272 1,684.46 1,600.24 1,840.28 # 17273 129.07 122.62 141.01 19290 165.95 157.65 181.30 17274 221.37 210.30 241.85 # 19290 63.17 60.01 69.01 # 17274 158.19 150.28 172.82 19291 71.58 68.00 78.20 17276 257.79 244.90 281.64 # 19291 31.14 29.58 34.02 # 17276 190.39 180.87 208.00 19295 105.19 99.93 114.92 17280 125.60 119.32 137.22 19296 4,588.16 4,358.75 5,012.56 # 17280 80.52 76.49 87.96 # 19296 190.81 181.27 208.46 17281 158.51 150.58 173.17 19297 85.76 81.47 93.69 # 17281 111.75 106.16 122.08 19298 1,567.58 1,489.20 1,712.58 17282 183.45 174.28 200.42 # 19298 310.60 295.07 339.33 # 17282 129.11 122.65 141.05 19300 516.49 490.67 564.27 17283 221.52 210.44 242.01 # 19300 349.25 331.79 381.56 # 17283 161.71 153.62 176.66 19301 530.91 504.36 580.01 17284 258.15 245.24 282.03 19302 785.49 746.22 858.15 # 17284 192.44 182.82 210.24 19303 817.82 776.93 893.47 17286 328.26 311.85 358.63 19304 499.35 474.38 545.54 # 17286 261.29 248.23 285.46 19305 978.35 929.43 1,068.84 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 8 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 19306 1,022.48 971.36 1,117.06 # 20526 55.11 52.35 60.20 19307 1,027.85 976.46 1,122.93 20550 56.23 53.42 61.43 19316 724.60 688.37 791.63 # 20550 38.96 37.01 42.56 19318 1,069.15 1,015.69 1,168.04 20551 55.51 52.73 60.64 19324 447.07 424.72 488.43 # 20551 40.77 38.73 44.54 19325 600.06 570.06 655.57 20552 51.12 48.56 55.84 19328 452.72 430.08 494.59 # 20552 33.01 31.36 36.06 19330 573.95 545.25 627.04 20553 57.26 54.40 62.56 19340 370.09 351.59 404.33 # 20553 36.62 34.79 40.01 19342 850.14 807.63 928.77 20555 307.23 291.87 335.65 19350 846.04 803.74 924.30 20600 52.45 49.83 57.30 # 19350 635.84 604.05 694.66 # 20600 38.54 36.61 42.10 19355 682.20 648.09 745.30 20605 57.00 54.15 62.27 # 19355 507.81 482.42 554.78 # 20605 39.73 37.74 43.40 19357 1,436.06 1,364.26 1,568.90 20610 72.69 69.06 79.42 19361 1,486.09 1,411.79 1,623.56 # 20610 47.42 45.05 51.81 19364 2,582.55 2,453.42 2,821.43 20612 56.26 53.45 61.47 19366 1,283.19 1,219.03 1,401.88 # 20612 41.10 39.05 44.91 19367 1,691.22 1,606.66 1,847.66 20615 214.86 204.12 234.74 19368 2,079.78 1,975.79 2,272.16 # 20615 152.52 144.89 166.62 19369 1,914.70 1,818.97 2,091.82 20650 186.75 177.41 204.02 19370 630.98 599.43 689.34 # 20650 148.42 141.00 162.15 19371 727.53 691.15 794.82 20660 248.73 236.29 271.73 19380 710.63 675.10 776.37 # 20660 217.98 207.08 238.14 19396 200.62 190.59 219.18 20661 438.75 416.81 479.33 # 19396 130.27 123.76 142.32 20662 445.90 423.61 487.15 20000 195.02 185.27 213.06 20663 421.91 400.81 460.93 # 20000 148.26 140.85 161.98 20664 698.35 663.43 762.94 20005 284.64 270.41 310.97 20665 124.71 118.47 136.24 # 20005 223.56 212.38 244.24 # 20665 99.43 94.46 108.63 20100 554.63 526.90 605.94 20670 450.33 427.81 491.98 20101 385.81 366.52 421.50 # 20670 147.46 140.09 161.10 # 20101 188.25 178.84 205.67 20680 573.02 544.37 626.03 20102 451.87 429.28 493.67 # 20680 380.09 361.09 415.25 # 20102 226.93 215.58 247.92 20690 466.22 442.91 509.35 20103 547.39 520.02 598.02 20692 857.90 815.01 937.26 # 20103 332.14 315.53 362.86 20693 440.47 418.45 481.22 20150 863.57 820.39 943.45 20694 425.62 404.34 464.99 20200 185.27 176.01 202.41 # 20694 322.42 306.30 352.25 # 20200 86.70 82.37 94.73 20802 2,263.50 2,150.33 2,472.88 20205 251.88 239.29 275.18 20805 2,974.41 2,825.69 3,249.54 # 20205 137.31 130.44 150.01 20808 3,855.10 3,662.35 4,211.70 20206 282.31 268.19 308.42 20816 2,348.91 2,231.46 2,566.18 # 20206 60.74 57.70 66.36 20822 2,064.45 1,961.23 2,255.41 20220 198.26 188.35 216.60 20824 2,322.12 2,206.01 2,536.91 # 20220 76.10 72.30 83.15 20827 2,109.33 2,003.86 2,304.44 20225 837.80 795.91 915.30 20838 2,236.04 2,124.24 2,442.88 # 20225 115.37 109.60 126.04 20900 594.97 565.22 650.00 20240 219.34 208.37 239.63 # 20900 445.85 423.56 487.09 20245 594.84 565.10 649.87 20902 579.45 550.48 633.05 20250 355.08 337.33 387.93 20910 409.41 388.94 447.28 20251 395.12 375.36 431.66 20912 463.59 440.41 506.47 20500 121.61 115.53 132.86 20920 383.02 363.87 418.45 # 20500 96.33 91.51 105.24 20922 569.91 541.41 622.62 20501 138.10 131.20 150.88 # 20922 459.54 436.56 502.04 # 20501 37.85 35.96 41.35 20924 482.36 458.24 526.98 20520 185.84 176.55 203.03 20926 413.23 392.57 451.46 # 20520 137.40 130.53 150.11 20931 107.57 102.19 117.52 20525 476.27 452.46 520.33 20937 163.61 155.43 178.74 # 20525 235.74 223.95 257.54 20938 178.07 169.17 194.55 20526 73.22 69.56 79.99 20950 281.94 267.84 308.02 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 9 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 20950 88.16 83.75 96.31 # 21084 1,386.56 1,317.23 1,514.81 20955 2,400.76 2,280.72 2,622.83 21085 662.39 629.27 723.66 20956 2,542.89 2,415.75 2,778.11 # 21085 558.77 530.83 610.45 20957 2,375.55 2,256.77 2,595.29 21086 1,724.39 1,638.17 1,883.90 20962 2,529.32 2,402.85 2,763.28 # 21086 1,539.47 1,462.50 1,681.88 20969 2,673.21 2,539.55 2,920.48 21087 1,709.14 1,623.68 1,867.23 20970 2,669.05 2,535.60 2,915.94 # 21087 1,528.42 1,452.00 1,669.80 20972 2,399.93 2,279.93 2,621.92 21100 720.41 684.39 787.05 20973 2,580.78 2,451.74 2,819.50 # 21100 380.89 361.85 416.13 20974 59.35 56.38 64.84 21110 693.99 659.29 758.18 # 20974 45.88 43.59 50.13 # 21110 598.79 568.85 654.18 20975 169.67 161.19 185.37 21116 173.09 164.44 189.11 20979 53.70 51.02 58.67 # 21116 40.82 38.78 44.60 # 20979 35.17 33.41 38.42 21120 612.65 582.02 669.32 20982 4,261.63 4,048.55 4,655.83 # 21120 484.18 459.97 528.97 # 20982 385.36 366.09 421.00 21121 716.26 680.45 782.52 20985 140.47 133.45 153.47 # 21121 611.79 581.20 668.38 21010 683.28 649.12 746.49 21122 681.77 647.68 744.83 21015 405.98 385.68 443.53 21123 796.65 756.82 870.34 21025 935.85 889.06 1,022.42 21125 2,896.07 2,751.27 3,163.96 # 21025 794.74 755.00 868.25 # 21125 695.08 660.33 759.38 21026 556.89 529.05 608.41 21127 3,152.01 2,994.41 3,443.57 # 21026 463.37 440.20 506.23 # 21127 816.23 775.42 891.73 21029 705.92 670.62 771.21 21137 701.02 665.97 765.87 # 21029 592.19 562.58 646.97 21138 847.20 804.84 925.57 21030 463.18 440.02 506.02 21139 918.95 873.00 1,003.95 # 21030 383.15 363.99 418.59 21141 1,259.11 1,196.15 1,375.57 21031 357.83 339.94 390.93 21142 1,229.02 1,167.57 1,342.71 # 21031 274.00 260.30 299.35 21143 1,300.62 1,235.59 1,420.93 21032 365.04 346.79 398.81 21145 1,450.10 1,377.60 1,584.24 # 21032 269.84 256.35 294.80 21146 1,438.19 1,366.28 1,571.22 21034 1,260.80 1,197.76 1,377.42 21147 1,556.74 1,478.90 1,700.74 # 21034 1,111.68 1,056.10 1,214.52 21150 1,657.15 1,574.29 1,810.43 21040 464.87 441.63 507.87 21151 1,771.75 1,683.16 1,935.63 # 21040 375.56 356.78 410.30 21154 1,987.61 1,888.23 2,171.46 21044 827.46 786.09 904.00 21155 2,267.21 2,153.85 2,476.93 21045 1,145.87 1,088.58 1,251.87 21159 2,626.58 2,495.25 2,869.54 21046 1,020.36 969.34 1,114.74 21160 2,778.32 2,639.40 3,035.31 21047 1,231.83 1,170.24 1,345.78 21172 1,634.02 1,552.32 1,785.17 21048 1,037.48 985.61 1,133.45 21175 1,934.29 1,837.58 2,113.22 21049 1,183.17 1,124.01 1,292.61 21179 1,379.30 1,310.34 1,506.89 21050 805.69 765.41 880.22 21180 1,562.24 1,484.13 1,706.75 21060 742.72 705.58 811.42 21181 684.40 650.18 747.71 21070 607.15 576.79 663.31 21182 1,904.91 1,809.66 2,081.11 21073 356.95 339.10 389.97 21183 2,179.27 2,070.31 2,380.86 # 21073 222.57 211.44 243.16 21184 2,262.77 2,149.63 2,472.07 21076 941.77 894.68 1,028.88 21188 1,554.34 1,476.62 1,698.11 # 21076 822.13 781.02 898.17 21193 1,170.39 1,111.87 1,278.65 21077 2,323.49 2,207.32 2,538.42 21194 1,333.92 1,267.22 1,457.30 # 21077 2,072.43 1,968.81 2,264.13 21195 1,274.61 1,210.88 1,392.51 21079 1,595.65 1,515.87 1,743.25 21196 1,381.25 1,312.19 1,509.02 # 21079 1,380.40 1,311.38 1,508.09 21198 1,084.05 1,029.85 1,184.33 21080 1,815.25 1,724.49 1,983.16 21199 954.90 907.16 1,043.23 # 21080 1,557.03 1,479.18 1,701.06 21206 1,054.59 1,001.86 1,152.14 21081 1,654.35 1,571.63 1,807.37 21208 1,578.67 1,499.74 1,724.70 # 21081 1,413.40 1,342.73 1,544.14 # 21208 780.00 741.00 852.15 21082 1,518.90 1,442.96 1,659.40 21209 767.22 728.86 838.19 # 21082 1,303.22 1,238.06 1,423.77 # 21209 608.42 578.00 664.70 21083 1,447.70 1,375.32 1,581.62 21210 1,864.26 1,771.05 2,036.71 # 21083 1,205.49 1,145.22 1,317.00 # 21210 782.09 742.99 854.44 21084 1,652.79 1,570.15 1,805.67 21215 3,145.75 2,988.46 3,436.73 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 10 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 21215 814.17 773.46 889.48 21387 716.11 680.30 782.35 21230 729.43 692.96 796.90 21390 713.07 677.42 779.03 21235 685.68 651.40 749.11 21395 902.83 857.69 986.34 # 21235 530.66 504.13 579.75 21400 165.26 157.00 180.55 21240 1,053.01 1,000.36 1,150.41 # 21400 134.08 127.38 146.49 21242 969.91 921.41 1,059.62 21401 448.59 426.16 490.08 21243 1,574.84 1,496.10 1,720.52 # 21401 269.57 256.09 294.50 21244 985.99 936.69 1,077.19 21406 508.57 483.14 555.61 21245 1,073.40 1,019.73 1,172.69 21407 598.43 568.51 653.79 # 21245 859.83 816.84 939.37 21408 815.34 774.57 890.76 21246 819.05 778.10 894.82 21421 677.02 643.17 739.65 21247 1,530.58 1,454.05 1,672.16 # 21421 586.88 557.54 641.17 21248 991.38 941.81 1,083.08 21422 639.24 607.28 698.37 # 21248 826.26 784.95 902.69 21423 752.32 714.70 821.91 21249 1,385.82 1,316.53 1,514.01 21431 711.80 676.21 777.64 # 21249 1,171.82 1,113.23 1,280.21 21432 633.39 601.72 691.98 21255 1,320.22 1,254.21 1,442.34 21433 1,567.68 1,489.30 1,712.70 21256 1,084.04 1,029.84 1,184.32 21435 1,237.10 1,175.25 1,351.54 21260 1,170.30 1,111.79 1,278.56 21436 1,767.54 1,679.16 1,931.03 21261 2,065.25 1,961.99 2,256.29 21440 484.08 459.88 528.86 21263 1,814.30 1,723.59 1,982.13 # 21440 409.10 388.65 446.95 21267 1,496.87 1,422.03 1,635.33 21445 691.63 657.05 755.61 21268 1,716.72 1,630.88 1,875.51 # 21445 582.11 553.00 635.95 21270 857.37 814.50 936.68 21450 506.95 481.60 553.84 # 21270 653.91 621.21 714.39 # 21450 437.45 415.58 477.92 21275 754.85 717.11 824.68 21451 673.89 640.20 736.23 21280 490.06 465.56 535.39 # 21451 584.17 554.96 638.20 21282 328.61 312.18 359.01 21452 613.81 583.12 670.59 21295 166.42 158.10 181.82 # 21452 310.51 294.98 339.23 21296 385.61 366.33 421.28 21453 776.84 738.00 848.70 21310 111.20 105.64 121.49 # 21453 710.29 674.78 776.00 # 21310 26.54 25.21 28.99 21454 519.34 493.37 567.38 21315 253.13 240.47 276.54 21461 1,730.13 1,643.62 1,890.16 # 21315 141.50 134.43 154.59 # 21461 872.48 828.86 953.19 21320 241.43 229.36 263.76 21462 1,889.49 1,795.02 2,064.27 # 21320 131.06 124.51 143.19 # 21462 952.22 904.61 1,040.30 21325 475.17 451.41 519.12 21465 857.75 814.86 937.09 21330 573.77 545.08 626.84 21470 1,108.84 1,053.40 1,211.41 21335 704.48 669.26 769.65 21480 92.01 87.41 100.52 21336 623.19 592.03 680.83 # 21480 30.09 28.59 32.88 21337 377.11 358.25 411.99 21485 597.83 567.94 653.13 # 21337 268.85 255.41 293.72 # 21485 523.27 497.11 571.68 21338 757.43 719.56 827.49 21490 863.55 820.37 943.43 21339 812.22 771.61 887.35 21495 633.16 601.50 691.73 21340 747.07 709.72 816.18 21497 600.90 570.86 656.49 21343 1,116.43 1,060.61 1,219.70 # 21497 523.39 497.22 571.80 21344 1,417.59 1,346.71 1,548.72 21501 417.06 396.21 455.64 21345 755.52 717.74 825.40 # 21501 298.27 283.36 325.86 # 21345 616.51 585.68 673.53 21502 494.74 470.00 540.50 21346 902.78 857.64 986.29 21510 449.52 427.04 491.10 21347 1,083.96 1,029.76 1,184.22 21550 242.22 230.11 264.63 21348 1,126.96 1,070.61 1,231.20 # 21550 148.70 141.27 162.46 21355 411.63 391.05 449.71 21555 403.22 383.06 440.52 # 21355 297.89 283.00 325.45 # 21555 304.65 289.42 332.83 21356 469.55 446.07 512.98 21556 383.27 364.11 418.73 # 21356 353.71 336.02 386.42 21557 541.54 514.46 591.63 21360 498.43 473.51 544.54 21600 517.35 491.48 565.20 21365 1,028.98 977.53 1,124.16 21610 999.15 949.19 1,091.57 21366 1,157.80 1,099.91 1,264.90 21615 641.51 609.43 700.84 21385 673.34 639.67 735.62 21616 785.72 746.43 858.39 21386 624.05 592.85 681.78 21620 497.59 472.71 543.62 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 11 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21627 522.77 496.63 571.12 22522 236.92 225.07 258.83 21630 1,187.25 1,127.89 1,297.07 22523 585.44 556.17 639.60 21632 1,171.26 1,112.70 1,279.61 22524 560.84 532.80 612.72 21685 929.29 882.83 1,015.25 22525 259.10 246.15 283.07 21700 406.34 386.02 443.92 22526 2,208.43 2,098.01 2,412.71 21705 584.36 555.14 638.41 # 22526 326.32 310.00 356.50 21720 359.17 341.21 392.39 22527 1,821.61 1,730.53 1,990.11 21725 499.24 474.28 545.42 # 22527 149.28 141.82 163.09 21740 1,013.08 962.43 1,106.79 22532 1,604.96 1,524.71 1,753.42 21750 672.96 639.31 735.21 22533 1,498.31 1,423.39 1,636.90 21800 92.55 87.92 101.11 22534 351.64 334.06 384.17 # 21800 93.81 89.12 102.49 22548 1,723.09 1,636.94 1,882.48 21805 242.61 230.48 265.05 22554 1,210.68 1,150.15 1,322.67 21810 479.53 455.55 523.88 22556 1,541.10 1,464.05 1,683.66 21820 125.99 119.69 137.64 22558 1,403.58 1,333.40 1,533.41 21825 539.89 512.90 589.84 22585 326.23 309.92 356.41 21920 236.98 225.13 258.90 22590 1,428.37 1,356.95 1,560.49 # 21920 145.15 137.89 158.57 22595 1,359.64 1,291.66 1,485.41 21925 392.97 373.32 429.32 22600 1,164.65 1,106.42 1,272.38 # 21925 310.41 294.89 339.12 22610 1,151.07 1,093.52 1,257.55 21930 438.53 416.60 479.09 22612 1,486.47 1,412.15 1,623.97 # 21930 342.07 324.97 373.72 22614 380.61 361.58 415.82 21935 1,076.08 1,022.28 1,175.62 22630 1,432.22 1,360.61 1,564.70 22010 839.84 797.85 917.53 22632 309.35 293.88 337.96 22015 834.14 792.43 911.29 22800 1,268.94 1,205.49 1,386.31 22100 760.41 722.39 830.75 22802 2,012.49 1,911.87 2,198.65 22101 759.15 721.19 829.37 22804 2,329.91 2,213.41 2,545.42 22102 761.62 723.54 832.07 22808 1,710.05 1,624.55 1,868.23 22103 136.43 129.61 149.05 22810 1,912.34 1,816.72 2,089.23 22110 934.46 887.74 1,020.90 22812 2,096.16 1,991.35 2,290.05 22112 929.99 883.49 1,016.01 22818 2,096.08 1,991.28 2,289.97 22114 932.45 885.83 1,018.70 22819 2,373.26 2,254.60 2,592.79 22116 136.62 129.79 149.26 22830 761.16 723.10 831.57 22206 2,183.16 2,074.00 2,385.10 22840 744.25 707.04 813.10 22207 2,156.44 2,048.62 2,355.91 22842 744.62 707.39 813.50 22208 545.56 518.28 596.02 22843 787.52 748.14 860.36 22210 1,643.87 1,561.68 1,795.93 22844 969.51 921.03 1,059.18 22212 1,359.68 1,291.70 1,485.46 22845 711.24 675.68 777.03 22214 1,374.18 1,305.47 1,501.29 22846 739.23 702.27 807.61 22216 357.32 339.45 390.37 22847 812.53 771.90 887.69 22220 1,487.25 1,412.89 1,624.82 22848 352.86 335.22 385.50 22222 1,350.03 1,282.53 1,474.91 22849 1,222.50 1,161.38 1,335.59 22224 1,468.51 1,395.08 1,604.34 22850 672.75 639.11 734.98 22226 355.64 337.86 388.54 22851 395.21 375.45 431.77 22305 175.81 167.02 192.07 22852 644.07 611.87 703.65 # 22305 160.23 152.22 175.05 22855 1,035.47 983.70 1,131.26 22310 261.80 248.71 286.02 22857 1,640.35 1,558.33 1,792.08 # 22310 242.00 229.90 264.39 22862 1,933.82 1,837.13 2,112.70 22315 802.98 762.83 877.25 22865 1,883.77 1,789.58 2,058.02 # 22315 701.88 666.79 766.81 22900 372.65 354.02 407.12 22318 1,481.70 1,407.62 1,618.76 23000 514.65 488.92 562.26 22319 1,624.41 1,543.19 1,774.67 # 23000 340.68 323.65 372.20 22325 1,289.60 1,225.12 1,408.89 23020 654.07 621.37 714.58 22326 1,351.13 1,283.57 1,476.11 23030 421.43 400.36 460.41 22327 1,333.30 1,266.64 1,456.64 # 23030 244.93 232.68 267.58 22328 268.18 254.77 292.99 23031 409.86 389.37 447.78 22505 117.04 111.19 127.87 # 23031 211.03 200.48 230.55 22520 2,584.35 2,455.13 2,823.40 23035 659.39 626.42 720.38 # 22520 565.33 537.06 617.62 23040 681.13 647.07 744.13 22521 2,465.99 2,342.69 2,694.09 23044 541.82 514.73 591.94 # 22521 534.17 507.46 583.58 23065 197.66 187.78 215.95 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 12 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 23065 153.85 146.16 168.08 23490 776.23 737.42 848.03 23066 486.37 462.05 531.36 23491 969.81 921.32 1,059.52 # 23066 321.25 305.19 350.97 23500 197.36 187.49 215.61 23075 246.52 234.19 269.32 # 23500 191.46 181.89 209.17 # 23075 165.22 156.96 180.50 23505 321.81 305.72 351.58 23076 525.37 499.10 573.97 # 23505 301.59 286.51 329.49 23077 1,098.60 1,043.67 1,200.22 23515 645.76 613.47 705.49 23100 461.27 438.21 503.94 23520 203.35 193.18 222.16 23101 427.10 405.75 466.61 # 23520 202.51 192.38 221.24 23105 603.29 573.13 659.10 23525 320.91 304.86 350.59 23106 454.10 431.40 496.11 # 23525 297.32 282.45 324.82 23107 628.08 596.68 686.18 23530 521.62 495.54 569.87 23120 532.66 506.03 581.93 23532 588.25 558.84 642.67 23125 663.99 630.79 725.41 23540 202.47 192.35 221.20 23130 575.14 546.38 628.34 # 23540 193.20 183.54 211.07 23140 482.58 458.45 527.22 23545 289.72 275.23 316.51 23145 651.62 619.04 711.90 # 23545 261.91 248.81 286.13 23146 583.97 554.77 637.99 23550 541.28 514.22 591.35 23150 614.02 583.32 670.82 23552 623.57 592.39 681.25 23155 744.46 707.24 813.33 23570 210.04 199.54 229.47 23156 636.85 605.01 695.76 # 23570 210.46 199.94 229.93 23170 505.39 480.12 552.14 23575 356.58 338.75 389.56 23172 521.97 495.87 570.25 # 23575 333.83 317.14 364.71 23174 711.21 675.65 777.00 23585 861.73 818.64 941.44 23180 667.61 634.23 729.36 23600 297.20 282.34 324.69 23182 642.69 610.56 702.14 # 23600 267.29 253.93 292.02 23184 720.36 684.34 786.99 23605 435.07 413.32 475.32 23190 525.39 499.12 573.99 # 23605 396.32 376.50 432.98 23195 705.98 670.68 771.28 23615 813.74 773.05 889.01 23200 820.18 779.17 896.05 23616 1,243.46 1,181.29 1,358.48 23210 859.63 816.65 939.15 23620 243.07 230.92 265.56 23220 1,014.38 963.66 1,108.21 # 23620 224.54 213.31 245.31 23221 1,183.96 1,124.76 1,293.47 23625 352.27 334.66 384.86 23222 1,591.27 1,511.71 1,738.47 # 23625 327.41 311.04 357.70 23330 218.75 207.81 238.98 23630 683.87 649.68 747.13 # 23330 142.09 134.99 155.24 23650 273.90 260.21 299.24 23331 557.81 529.92 609.41 # 23650 242.73 230.59 265.18 23332 838.29 796.38 915.84 23655 352.79 335.15 385.42 23350 166.13 157.82 181.49 23660 548.15 520.74 598.85 # 23350 49.87 47.38 54.49 23665 389.11 369.65 425.10 23395 1,213.18 1,152.52 1,325.40 # 23665 363.83 345.64 397.49 23397 1,084.67 1,030.44 1,185.01 23670 760.88 722.84 831.27 23400 924.81 878.57 1,010.36 23675 510.35 484.83 557.55 23405 598.48 568.56 653.84 # 23675 468.65 445.22 512.00 23406 745.95 708.65 814.95 23680 835.68 793.90 912.99 23410 853.81 811.12 932.79 23700 185.03 175.78 202.15 23412 907.48 862.11 991.43 23800 969.66 921.18 1,059.36 23415 700.20 665.19 764.97 23802 1,145.62 1,088.34 1,251.59 23420 1,000.79 950.75 1,093.36 23900 1,256.52 1,193.69 1,372.74 23430 704.99 669.74 770.20 23920 1,019.14 968.18 1,113.41 23440 727.17 690.81 794.43 23921 422.20 401.09 461.25 23450 908.51 863.08 992.54 23930 350.99 333.44 383.46 23455 966.43 918.11 1,055.83 # 23930 203.56 193.38 222.39 23460 1,046.52 994.19 1,143.32 23931 285.89 271.60 312.34 23462 1,022.78 971.64 1,117.39 # 23931 151.94 144.34 165.99 23465 1,064.37 1,011.15 1,162.82 23935 475.29 451.53 519.26 23466 1,049.41 996.94 1,146.48 24000 445.19 422.93 486.37 23470 1,160.46 1,102.44 1,267.81 24006 672.27 638.66 734.46 23472 1,428.43 1,357.01 1,560.56 24065 231.07 219.52 252.45 23480 782.97 743.82 855.39 # 24065 153.14 145.48 167.30 23485 916.98 871.13 1,001.80 24066 564.25 536.04 616.45 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 13 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 24066 371.32 352.75 405.66 24410 994.43 944.71 1,086.42 24075 456.88 434.04 499.15 24420 925.50 879.23 1,011.11 # 24075 290.91 276.36 317.81 24430 975.25 926.49 1,065.46 24076 442.08 419.98 482.98 24435 1,002.16 952.05 1,094.86 24077 762.84 724.70 833.41 24470 623.80 592.61 681.50 24100 375.41 356.64 410.14 24495 635.04 603.29 693.78 24101 471.16 447.60 514.74 24498 829.61 788.13 906.35 24102 582.31 553.19 636.17 24500 322.09 305.99 351.89 24105 319.51 303.53 349.06 # 24500 284.18 269.97 310.47 24110 549.84 522.35 600.70 24505 465.88 442.59 508.98 24115 631.31 599.74 689.70 # 24505 420.39 399.37 459.28 24116 823.60 782.42 899.78 24515 832.42 790.80 909.42 24120 493.43 468.76 539.07 24516 821.55 780.47 897.54 24125 558.66 530.73 610.34 24530 346.87 329.53 378.96 24126 596.69 566.86 651.89 # 24530 306.86 291.52 335.25 24130 479.47 455.50 523.83 24535 579.25 550.29 632.83 24134 722.06 685.96 788.85 # 24535 533.33 506.66 582.66 24136 595.15 565.39 650.20 24538 709.28 673.82 774.89 24138 622.45 591.33 680.03 24545 846.20 803.89 924.47 24140 693.85 659.16 758.03 24546 1,010.09 959.59 1,103.53 24145 586.06 556.76 640.27 24560 291.36 276.79 318.31 24147 612.02 581.42 668.63 # 24560 249.65 237.17 272.75 24149 1,079.95 1,025.95 1,179.84 24565 483.03 458.88 527.71 24150 922.03 875.93 1,007.32 # 24565 441.33 419.26 482.15 24151 1,067.96 1,014.56 1,166.74 24566 653.21 620.55 713.63 24152 683.08 648.93 746.27 24575 701.77 666.68 766.68 24153 638.26 606.35 697.30 24576 306.47 291.15 334.82 24155 795.30 755.54 868.87 # 24576 269.40 255.93 294.32 24160 573.43 544.76 626.47 24577 500.15 475.14 546.41 24164 469.83 446.34 513.29 # 24577 457.18 434.32 499.47 24200 195.95 186.15 214.07 24579 790.53 751.00 863.65 # 24200 128.98 122.53 140.91 24582 742.80 705.66 811.51 24201 548.41 520.99 599.14 24586 1,040.60 988.57 1,136.86 # 24201 343.69 326.51 375.49 24587 1,032.75 981.11 1,128.28 24220 179.20 170.24 195.78 24600 343.24 326.08 374.99 # 24220 65.46 62.19 71.52 # 24600 302.38 287.26 330.35 24300 379.04 360.09 414.10 24605 428.83 407.39 468.50 24301 712.44 676.82 778.34 24615 679.14 645.18 741.96 24305 548.74 521.30 599.50 24620 518.28 492.37 566.23 24310 449.79 427.30 491.40 24635 794.81 755.07 868.33 24320 721.65 685.57 788.41 24640 115.83 110.04 126.55 24330 680.55 646.52 743.50 # 24640 78.76 74.82 86.04 24331 748.66 711.23 817.91 24650 236.93 225.08 258.84 24332 566.70 538.37 619.13 # 24650 206.18 195.87 225.25 24340 582.17 553.06 636.02 24655 407.11 386.75 444.76 24341 678.16 644.25 740.89 # 24655 366.25 347.94 400.13 24342 746.73 709.39 815.80 24665 615.23 584.47 672.14 24343 665.50 632.23 727.06 24666 693.99 659.29 758.18 24344 1,028.95 977.50 1,124.13 24670 265.25 251.99 289.79 24345 662.01 628.91 723.25 # 24670 231.13 219.57 252.51 24346 1,025.95 974.65 1,120.85 24675 425.82 404.53 465.21 24357 422.51 401.38 461.59 # 24675 387.06 367.71 422.87 24358 494.36 469.64 540.09 24685 618.57 587.64 675.79 24359 602.59 572.46 658.33 24800 758.74 720.80 828.92 24360 849.58 807.10 928.17 24802 938.34 891.42 1,025.13 24361 955.09 907.34 1,043.44 24900 668.82 635.38 730.69 24362 923.38 877.21 1,008.79 24920 659.92 626.92 720.96 24363 1,395.05 1,325.30 1,524.10 24925 509.47 484.00 556.60 24365 607.13 576.77 663.29 24930 695.49 660.72 759.83 24366 650.06 617.56 710.19 24931 734.31 697.59 802.23 24400 780.21 741.20 852.38 24935 1,004.17 953.96 1,097.05 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 14 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 25000 361.43 343.36 394.86 25310 714.86 679.12 780.99 25001 313.04 297.39 342.00 25312 804.95 764.70 879.41 25020 577.56 548.68 630.98 25315 857.30 814.44 936.61 25023 1,077.20 1,023.34 1,176.84 25316 990.30 940.79 1,081.91 25024 706.04 670.74 771.35 25320 914.09 868.39 998.65 25025 1,069.59 1,016.11 1,168.53 25332 800.59 760.56 874.64 25028 505.84 480.55 552.63 25335 924.57 878.34 1,010.09 25031 400.55 380.52 437.60 25337 849.82 807.33 928.43 25035 696.65 661.82 761.09 25350 775.16 736.40 846.86 25040 552.41 524.79 603.51 25355 853.74 811.05 932.71 25065 231.61 220.03 253.03 25360 757.14 719.28 827.17 # 25065 154.10 146.40 168.36 25365 998.34 948.42 1,090.68 25066 389.90 370.41 425.97 25370 1,067.90 1,014.51 1,166.69 25075 337.97 321.07 369.23 25375 1,043.34 991.17 1,139.85 25076 477.88 453.99 522.09 25390 863.12 819.96 942.95 25077 762.02 723.92 832.51 25391 1,075.65 1,021.87 1,175.15 25085 460.30 437.29 502.88 25392 1,075.13 1,021.37 1,174.58 25100 341.59 324.51 373.19 25393 1,209.67 1,149.19 1,321.57 25101 398.09 378.19 434.92 25394 725.69 689.41 792.82 25105 485.66 461.38 530.59 25400 904.92 859.67 988.62 25107 589.89 560.40 644.46 25405 1,124.14 1,067.93 1,228.12 25109 479.63 455.65 524.00 25415 1,060.03 1,007.03 1,158.08 25110 377.38 358.51 412.29 25420 1,243.22 1,181.06 1,358.22 25111 307.33 291.96 335.75 25425 1,150.69 1,093.16 1,257.13 25112 372.27 353.66 406.71 25426 1,169.75 1,111.26 1,277.95 25115 823.63 782.45 899.82 25430 664.26 631.05 725.71 25116 689.91 655.41 753.72 25431 748.19 710.78 817.40 25118 378.09 359.19 413.07 25440 748.86 711.42 818.13 25119 501.38 476.31 547.76 25441 888.13 843.72 970.28 25120 600.12 570.11 655.63 25442 762.16 724.05 832.66 25125 677.32 643.45 739.97 25443 733.21 696.55 801.03 25126 693.07 658.42 757.18 25444 779.51 740.53 851.61 25130 438.53 416.60 479.09 25445 685.53 651.25 748.94 25135 542.44 515.32 592.62 25446 1,115.54 1,059.76 1,218.72 25136 480.96 456.91 525.45 25447 766.36 728.04 837.25 25145 611.31 580.74 667.85 25449 979.95 930.95 1,070.59 25150 569.03 540.58 621.67 25450 604.57 574.34 660.49 25151 678.31 644.39 741.05 25455 725.32 689.05 792.41 25170 910.83 865.29 995.08 25490 795.32 755.55 868.88 25210 478.64 454.71 522.92 25491 834.40 792.68 911.58 25215 618.17 587.26 675.35 25492 985.39 936.12 1,076.54 25230 426.12 404.81 465.53 25500 240.16 228.15 262.37 25240 441.24 419.18 482.06 # 25500 212.78 202.14 232.46 25246 181.95 172.85 198.78 25505 466.84 443.50 510.03 # 25246 72.85 69.21 79.59 # 25505 425.13 403.87 464.45 25248 462.20 439.09 504.95 25515 633.14 601.48 691.70 25250 494.71 469.97 540.47 25520 511.31 485.74 558.60 25251 674.08 640.38 736.44 # 25520 482.66 458.53 527.31 25259 378.14 359.23 413.11 25525 780.92 741.87 853.15 25260 717.15 681.29 783.48 25526 971.14 922.58 1,060.97 25263 710.07 674.57 775.76 25530 235.17 223.41 256.92 25265 831.57 789.99 908.49 # 25530 205.68 195.40 224.71 25270 591.34 561.77 646.04 25535 447.00 424.65 488.35 25272 658.00 625.10 718.87 # 25535 416.67 395.84 455.22 25274 760.02 722.02 830.32 25545 601.35 571.28 656.97 25275 633.41 601.74 692.00 25560 243.57 231.39 266.10 25280 661.55 628.47 722.74 # 25560 209.87 199.38 229.29 25290 615.55 584.77 672.49 25565 486.60 462.27 531.61 25295 620.94 589.89 678.37 # 25565 439.00 417.05 479.61 25300 656.15 623.34 716.84 25574 617.95 587.05 675.11 25301 625.13 593.87 682.95 25575 839.99 797.99 917.69 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 15 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 25600 267.35 253.98 292.08 26055 607.00 576.65 663.15 # 25600 232.81 221.17 254.35 # 26055 277.58 263.70 303.26 25605 563.98 535.78 616.15 26060 247.92 235.52 270.85 # 25605 527.33 500.96 576.10 26070 275.41 261.64 300.89 25606 641.06 609.01 700.36 26075 295.94 281.14 323.31 25607 659.71 626.72 720.73 26080 360.41 342.39 393.75 25608 750.38 712.86 819.79 26100 305.89 290.60 334.19 25609 954.99 907.24 1,043.33 26105 311.06 295.51 339.84 25622 275.09 261.34 300.54 26110 297.65 282.77 325.19 # 25622 238.87 226.93 260.97 26115 633.17 601.51 691.74 25624 430.36 408.84 470.17 # 26115 339.56 322.58 370.97 # 25624 386.13 366.82 421.84 26116 453.07 430.42 494.98 25628 671.28 637.72 733.38 26117 608.16 577.75 664.41 25630 280.06 266.06 305.97 26121 563.74 535.55 615.88 # 25630 243.41 231.24 265.93 26123 761.59 723.51 832.04 25635 406.24 385.93 443.82 26125 267.30 253.94 292.03 # 25635 346.85 329.51 378.94 26130 429.10 407.65 468.80 25645 539.92 512.92 589.86 26135 520.58 494.55 568.73 25650 290.83 276.29 317.73 26140 474.45 450.73 518.34 # 25650 258.39 245.47 282.29 26145 481.36 457.29 525.88 25651 441.65 419.57 482.51 26160 582.82 553.68 636.73 25652 580.77 551.73 634.49 # 26160 301.43 286.36 329.31 25660 371.17 352.61 405.50 26170 379.60 360.62 414.71 25670 578.01 549.11 631.48 26180 413.34 392.67 451.57 25671 490.03 465.53 535.36 26185 486.02 461.72 530.98 25675 397.53 377.65 434.30 26200 423.25 402.09 462.40 # 25675 360.88 342.84 394.27 26205 568.56 540.13 621.15 25676 599.00 569.05 654.41 26210 413.71 393.02 451.97 25680 420.66 399.63 459.57 26215 521.18 495.12 569.39 25685 688.42 654.00 752.10 26230 474.56 450.83 518.45 25690 432.90 411.26 472.95 26235 465.67 442.39 508.75 25695 599.30 569.34 654.74 26236 414.21 393.50 452.53 25800 717.93 682.03 784.33 26250 545.16 517.90 595.59 25805 823.70 782.52 899.90 26255 854.86 812.12 933.94 25810 825.59 784.31 901.96 26260 515.18 489.42 562.83 25820 590.82 561.28 645.47 26261 619.22 588.26 676.50 25825 720.38 684.36 787.01 26262 431.99 410.39 471.95 25830 933.92 887.22 1,020.30 26320 324.06 307.86 354.04 25900 765.37 727.10 836.17 26340 299.96 284.96 327.70 25905 749.34 711.87 818.65 26350 741.93 704.83 810.55 25907 672.03 638.43 734.19 26352 831.26 789.70 908.16 25909 746.00 708.70 815.01 26356 1,057.55 1,004.67 1,155.37 25915 1,198.54 1,138.61 1,309.40 26357 879.74 835.75 961.11 25920 645.68 613.40 705.41 26358 934.53 887.80 1,020.97 25922 569.21 540.75 621.86 26370 794.13 754.42 867.58 25924 632.86 601.22 691.40 26372 912.63 867.00 997.05 25927 769.85 731.36 841.06 26373 869.10 825.65 949.50 25929 537.65 510.77 587.39 26390 830.36 788.84 907.17 25931 719.21 683.25 785.74 26392 985.24 935.98 1,076.38 26010 260.56 247.53 284.66 26410 592.29 562.68 647.08 # 26010 124.07 117.87 135.55 26412 705.50 670.23 770.76 26011 402.30 382.19 439.52 26415 718.85 682.91 785.35 # 26011 174.83 166.09 191.00 26416 840.73 798.69 918.49 26020 402.60 382.47 439.84 26418 597.56 567.68 652.83 26025 392.93 373.28 429.27 26420 735.21 698.45 803.22 26030 461.24 438.18 503.91 26426 623.29 592.13 680.95 26034 501.14 476.08 547.49 26428 765.90 727.61 836.75 26035 757.31 719.44 827.36 26432 515.81 490.02 563.52 26037 535.58 508.80 585.12 26433 552.62 524.99 603.74 26040 291.52 276.94 318.48 26434 646.04 613.74 705.80 26045 439.72 417.73 480.39 26437 633.53 601.85 692.13 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 16 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 26440 655.64 622.86 716.29 26600 249.73 237.24 272.83 26442 942.09 894.99 1,029.24 # 26600 221.92 210.82 242.44 26445 617.07 586.22 674.15 26605 295.23 280.47 322.54 26449 798.98 759.03 872.88 # 26605 264.06 250.86 288.49 26450 406.80 386.46 444.43 26607 443.69 421.51 484.74 26455 403.66 383.48 441.00 26608 451.50 428.93 493.27 26460 392.84 373.20 429.18 26615 497.39 472.52 543.40 26471 623.00 591.85 680.63 26641 328.21 311.80 358.57 26474 604.76 574.52 660.70 # 26641 293.25 278.59 320.38 26476 585.93 556.63 640.12 26645 377.18 358.32 412.07 26477 592.92 563.27 647.76 # 26645 342.22 325.11 373.88 26478 638.12 606.21 697.14 26650 447.35 424.98 488.73 26479 630.06 598.56 688.34 26665 562.24 534.13 614.25 26480 779.43 740.46 851.53 26670 303.84 288.65 331.95 26483 862.19 819.08 941.94 # 26670 263.82 250.63 288.22 26485 833.05 791.40 910.11 26675 408.45 388.03 446.23 26489 849.16 806.70 927.71 # 26675 371.39 352.82 405.74 26490 780.24 741.23 852.41 26676 474.58 450.85 518.48 26492 863.20 820.04 943.05 26685 521.13 495.07 569.33 26494 794.79 755.05 868.31 26686 582.87 553.73 636.79 26496 850.49 807.97 929.17 26700 285.37 271.10 311.77 26497 854.84 812.10 933.92 # 26700 258.83 245.89 282.77 26498 1,124.82 1,068.58 1,228.87 26705 375.92 357.12 410.69 26499 807.40 767.03 882.08 # 26705 339.27 322.31 370.66 26500 634.64 602.91 693.35 26706 405.96 385.66 443.51 26502 705.86 670.57 771.16 26715 501.95 476.85 548.38 26508 644.86 612.62 704.51 26720 177.62 168.74 194.05 26510 608.69 578.26 665.00 # 26720 156.56 148.73 171.04 26516 709.55 674.07 775.18 26725 317.17 301.31 346.51 26517 819.19 778.23 894.96 # 26725 276.31 262.49 301.86 26518 820.54 779.51 896.44 26727 444.82 422.58 485.97 26520 684.80 650.56 748.14 26735 519.56 493.58 567.62 26525 688.36 653.94 752.03 26740 205.73 195.44 224.76 26530 502.86 477.72 549.38 # 26740 190.57 181.04 208.20 26531 585.21 555.95 639.34 26742 343.97 326.77 375.79 26535 365.52 347.24 399.33 # 26742 305.64 290.36 333.91 26536 644.31 612.09 703.90 26746 619.73 588.74 677.05 26540 669.04 635.59 730.93 26750 165.11 156.85 180.38 26541 806.09 765.79 880.66 # 26750 155.42 147.65 169.80 26542 687.76 653.37 751.38 26755 290.70 276.17 317.60 26545 701.61 666.53 766.51 # 26755 243.94 231.74 266.50 26546 956.43 908.61 1,044.90 26756 394.85 375.11 431.38 26548 765.64 727.36 836.46 26765 419.99 398.99 458.84 26550 1,478.24 1,404.33 1,614.98 26770 245.60 233.32 268.32 26551 2,913.60 2,767.92 3,183.11 # 26770 216.12 205.31 236.11 26553 2,745.85 2,608.56 2,999.84 26775 350.73 333.19 383.17 26554 3,744.64 3,557.41 4,091.02 # 26775 306.08 290.78 334.40 26555 1,325.07 1,258.82 1,447.64 26776 419.30 398.34 458.09 26556 2,829.46 2,687.99 3,091.19 26785 454.79 432.05 496.86 26560 555.49 527.72 606.88 26820 788.48 749.06 861.42 26561 874.76 831.02 955.67 26841 742.28 705.17 810.95 26562 1,166.90 1,108.56 1,274.84 26842 794.02 754.32 867.47 26565 684.32 650.10 747.62 26843 733.98 697.28 801.87 26567 686.52 652.19 750.02 26844 813.76 773.07 889.03 26568 904.36 859.14 988.01 26850 700.53 665.50 765.33 26580 1,220.03 1,159.03 1,332.88 26852 790.73 751.19 863.87 26587 894.14 849.43 976.84 26860 577.29 548.43 630.69 26590 1,264.11 1,200.90 1,381.04 26861 101.32 96.25 110.69 26591 459.62 436.64 502.14 26862 726.91 690.56 794.14 26593 604.09 573.89 659.97 26863 226.27 214.96 247.20 26596 691.12 656.56 755.04 26910 704.37 669.15 769.52 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 17 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 26951 609.72 579.23 666.11 27134 1,850.41 1,757.89 2,021.57 26952 656.04 623.24 716.73 27137 1,412.88 1,342.24 1,543.58 26990 583.86 554.67 637.87 27138 1,469.42 1,395.95 1,605.34 26991 685.37 651.10 748.77 27140 855.56 812.78 934.70 # 26991 486.12 461.81 531.08 27146 1,202.15 1,142.04 1,313.35 26992 912.43 866.81 996.83 27147 1,378.45 1,309.53 1,505.96 27000 426.78 405.44 466.26 27151 1,364.16 1,295.95 1,490.34 27001 513.77 488.08 561.29 27156 1,633.21 1,551.55 1,784.28 27003 550.99 523.44 601.96 27158 1,274.62 1,210.89 1,392.52 27005 689.41 654.94 753.18 27161 1,160.98 1,102.93 1,268.37 27006 698.92 663.97 763.57 27165 1,286.57 1,222.24 1,405.58 27025 836.10 794.30 913.45 27170 1,117.97 1,062.07 1,221.38 27030 897.60 852.72 980.63 27175 606.87 576.53 663.01 27033 928.21 881.80 1,014.07 27176 860.59 817.56 940.19 27035 1,062.76 1,009.62 1,161.06 27177 1,049.63 997.15 1,146.72 27036 946.00 898.70 1,033.51 27178 839.54 797.56 917.19 27040 325.40 309.13 355.50 27179 926.22 879.91 1,011.90 # 27040 187.23 177.87 204.55 27181 1,007.09 956.74 1,100.25 27041 641.41 609.34 700.74 27185 696.95 662.10 761.42 27047 582.21 553.10 636.07 27187 947.91 900.51 1,035.59 # 27047 479.43 455.46 523.78 27193 435.62 413.84 475.92 27048 443.03 420.88 484.01 # 27193 438.15 416.24 478.68 27049 924.81 878.57 1,010.36 27194 690.38 655.86 754.24 27050 331.55 314.97 362.22 27200 162.24 154.13 177.25 27052 520.89 494.85 569.08 # 27200 163.93 155.73 179.09 27054 642.39 610.27 701.81 27202 735.20 698.44 803.21 27060 403.28 383.12 440.59 27215 699.49 664.52 764.20 27062 425.29 404.03 464.63 27216 1,005.03 954.78 1,098.00 27065 467.63 444.25 510.89 27217 962.85 914.71 1,051.92 27066 761.98 723.88 832.46 27218 1,290.42 1,225.90 1,409.79 27067 958.66 910.73 1,047.34 27220 490.39 465.87 535.75 27070 800.52 760.49 874.56 # 27220 486.18 461.87 531.15 27071 863.86 820.67 943.77 27222 927.34 880.97 1,013.12 27075 2,156.30 2,048.49 2,355.76 27226 949.21 901.75 1,037.01 27076 1,506.31 1,430.99 1,645.64 27227 1,579.31 1,500.34 1,725.39 27077 2,518.44 2,392.52 2,751.40 27228 1,807.85 1,717.46 1,975.08 27078 952.89 905.25 1,041.04 27230 440.94 418.89 481.72 27079 931.88 885.29 1,018.08 # 27230 430.41 408.89 470.22 27080 456.02 433.22 498.20 27232 729.35 692.88 796.81 27086 244.29 232.08 266.89 27235 865.80 822.51 945.89 # 27086 140.67 133.64 153.69 27236 1,116.78 1,060.94 1,220.08 27087 594.51 564.78 649.50 27238 423.70 402.52 462.90 27090 790.48 750.96 863.60 27240 898.82 853.88 981.96 27091 1,498.17 1,423.26 1,636.75 27244 1,100.79 1,045.75 1,202.61 27093 208.11 197.70 227.36 27245 1,346.70 1,279.37 1,471.28 # 27093 67.84 64.45 74.12 27246 360.68 342.65 394.05 27095 253.65 240.97 277.12 27248 721.43 685.36 788.16 # 27095 76.31 72.49 83.36 27250 450.00 427.50 491.63 27096 194.48 184.76 212.47 27252 711.90 676.31 777.76 # 27096 63.47 60.30 69.35 27253 900.21 855.20 983.48 27097 625.33 594.06 683.17 27254 1,205.62 1,145.34 1,317.14 27098 590.62 561.09 645.25 27256 284.45 270.23 310.76 27100 772.98 734.33 844.48 # 27256 230.95 219.40 252.31 27105 801.75 761.66 875.91 27257 314.22 298.51 343.29 27110 892.37 847.75 974.91 27258 1,049.81 997.32 1,146.92 27111 841.88 799.79 919.76 27259 1,456.79 1,383.95 1,591.54 27120 1,215.00 1,154.25 1,327.39 27265 375.94 357.14 410.71 27122 1,048.75 996.31 1,145.76 27266 547.35 519.98 597.98 27125 1,058.05 1,005.15 1,155.92 27267 393.82 374.13 430.25 27130 1,363.32 1,295.15 1,489.42 27268 482.49 458.37 527.13 27132 1,594.92 1,515.17 1,742.45 27269 1,137.65 1,080.77 1,242.89 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 18 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 27275 172.57 163.94 188.53 27415 1,311.84 1,246.25 1,433.19 27280 969.08 920.63 1,058.72 27416 895.86 851.07 978.73 27282 783.84 744.65 856.35 27418 790.74 751.20 863.88 27284 1,523.32 1,447.15 1,664.22 27420 710.41 674.89 776.12 27286 1,535.80 1,459.01 1,677.86 27422 708.15 672.74 773.65 27290 1,477.97 1,404.07 1,614.68 27424 708.92 673.47 774.49 27295 1,188.99 1,129.54 1,298.97 27425 421.00 399.95 459.94 27301 641.32 609.25 700.64 27427 681.03 646.98 744.03 # 27301 462.30 439.19 505.07 27428 1,039.23 987.27 1,135.36 27303 603.90 573.71 659.77 27429 1,162.19 1,104.08 1,269.69 27305 443.52 421.34 484.54 27430 702.56 667.43 767.54 27306 368.07 349.67 402.12 27435 750.16 712.65 819.55 27307 446.06 423.76 487.32 27437 625.74 594.45 683.62 27310 684.39 650.17 747.70 27438 793.93 754.23 867.36 27323 247.65 235.27 270.56 27440 698.86 663.92 763.51 # 27323 165.51 157.23 180.81 27441 739.04 702.09 807.40 27324 358.20 340.29 391.33 27442 825.57 784.29 901.93 27325 481.36 457.29 525.88 27443 777.16 738.30 849.05 27326 464.76 441.52 507.75 27445 1,197.96 1,138.06 1,308.77 27327 425.42 404.15 464.77 27446 1,066.49 1,013.17 1,165.15 # 27327 325.58 309.30 355.70 27447 1,464.57 1,391.34 1,600.04 27328 392.79 373.15 429.12 27448 781.51 742.43 853.79 27329 962.70 914.57 1,051.76 27450 970.49 921.97 1,060.27 27330 381.49 362.42 416.78 27454 1,223.81 1,162.62 1,337.01 27331 448.14 425.73 489.59 27455 897.98 853.08 981.04 27332 603.24 573.08 659.04 27457 923.14 876.98 1,008.53 27333 548.93 521.48 599.70 27465 1,129.39 1,072.92 1,233.86 27334 643.21 611.05 702.71 27466 1,122.96 1,066.81 1,226.83 27335 725.53 689.25 792.64 27468 1,264.29 1,201.08 1,381.24 27340 345.39 328.12 377.34 27470 1,119.46 1,063.49 1,223.01 27345 453.67 430.99 495.64 27472 1,210.99 1,150.44 1,323.01 27347 476.39 452.57 520.46 27475 621.43 590.36 678.91 27350 615.02 584.27 671.91 27477 692.85 658.21 756.94 27355 571.09 542.54 623.92 27479 913.58 867.90 998.09 27356 695.39 660.62 759.71 27485 637.25 605.39 696.20 27357 771.56 732.98 842.93 27486 1,336.99 1,270.14 1,460.66 27358 275.92 262.12 301.44 27487 1,684.11 1,599.90 1,839.89 27360 809.42 768.95 884.29 27488 1,132.53 1,075.90 1,237.29 27365 1,155.00 1,097.25 1,261.84 27495 1,078.08 1,024.18 1,177.81 27370 176.54 167.71 192.87 27496 477.26 453.40 521.41 # 27370 49.32 46.85 53.88 27497 513.98 488.28 561.52 27372 584.85 555.61 638.95 27498 560.22 532.21 612.04 # 27372 381.81 362.72 417.13 27499 628.16 596.75 686.26 27380 565.90 537.61 618.25 27500 482.58 458.45 527.22 27381 764.22 726.01 834.91 # 27500 442.14 420.03 483.03 27385 604.38 574.16 660.28 27501 472.36 448.74 516.05 27386 794.34 754.62 867.81 # 27501 461.83 438.74 504.55 27390 413.07 392.42 451.28 27502 748.87 711.43 818.14 27391 541.44 514.37 591.53 27503 757.78 719.89 827.87 27392 668.43 635.01 730.26 27506 1,255.83 1,193.04 1,372.00 27393 479.83 455.84 524.22 27507 937.47 890.60 1,024.19 27394 618.90 587.96 676.15 27508 490.38 465.86 535.74 27395 833.83 792.14 910.96 # 27508 456.26 433.45 498.47 27396 582.15 553.04 636.00 27509 616.34 585.52 673.35 27397 842.07 799.97 919.97 27510 659.08 626.13 720.05 27400 640.13 608.12 699.34 27511 983.76 934.57 1,074.76 27403 608.87 578.43 665.19 27513 1,237.22 1,175.36 1,351.66 27405 640.21 608.20 699.43 27514 1,025.82 974.53 1,120.71 27407 734.63 697.90 802.59 27516 462.81 439.67 505.62 27409 909.52 864.04 993.65 # 27516 431.64 410.06 471.57 27412 1,558.55 1,480.62 1,702.71 27517 632.29 600.68 690.78 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 19 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 27519 919.09 873.14 1,004.11 27640 839.99 797.99 917.69 27520 295.02 280.27 322.31 27641 676.59 642.76 739.17 # 27520 259.63 246.65 283.65 27645 1,009.99 959.49 1,103.41 27524 718.51 682.58 784.97 27646 901.24 856.18 984.61 27530 367.29 348.93 401.27 27647 785.16 745.90 857.79 # 27530 336.54 319.71 367.67 27648 169.80 161.31 185.51 27532 578.42 549.50 631.93 # 27648 49.32 46.85 53.88 # 27532 543.03 515.88 593.26 27650 671.38 637.81 733.48 27535 878.45 834.53 959.71 27652 715.91 680.11 782.13 27536 1,122.38 1,066.26 1,226.20 27654 672.75 639.11 734.98 27538 437.98 416.08 478.49 27656 524.31 498.09 572.80 # 27538 405.13 384.87 442.60 # 27656 331.80 315.21 362.49 27540 801.31 761.24 875.43 27658 371.35 352.78 405.70 27550 456.66 433.83 498.90 27659 486.29 461.98 531.28 # 27550 418.74 397.80 457.47 27664 357.41 339.54 390.47 27552 586.96 557.61 641.25 27665 407.04 386.69 444.69 27556 907.89 862.50 991.88 27675 497.43 472.56 543.44 27557 1,076.19 1,022.38 1,175.74 27676 594.64 564.91 649.65 27558 1,179.49 1,120.52 1,288.60 27680 418.94 397.99 457.69 27560 334.40 317.68 365.33 27681 500.92 475.87 547.25 # 27560 288.49 274.07 315.18 27685 589.82 560.33 644.38 27562 423.64 402.46 462.83 # 27685 462.61 439.48 505.40 27566 851.88 809.29 930.68 27686 543.40 516.23 593.66 27570 140.05 133.05 153.01 27687 449.25 426.79 490.81 27580 1,375.70 1,306.92 1,502.96 27690 589.32 559.85 643.83 27590 770.98 732.43 842.29 27691 699.97 664.97 764.72 27591 864.61 821.38 944.59 27692 107.42 102.05 117.36 27592 654.87 622.13 715.45 27695 480.17 456.16 524.58 27594 481.10 457.05 525.61 27696 570.53 542.00 623.30 27596 693.29 658.63 757.42 27698 634.71 602.97 693.42 27598 702.23 667.12 767.19 27700 590.71 561.17 645.35 27600 401.60 381.52 438.75 27702 956.15 908.34 1,044.59 27601 414.55 393.82 452.89 27703 1,093.00 1,038.35 1,194.10 27602 491.80 467.21 537.29 27704 534.04 507.34 583.44 27603 501.40 476.33 547.78 27705 735.96 699.16 804.03 # 27603 364.92 346.67 398.67 27707 378.82 359.88 413.86 27604 437.91 416.01 478.41 27709 1,018.27 967.36 1,112.46 # 27604 328.38 311.96 358.75 27712 1,029.07 977.62 1,124.26 27605 380.15 361.14 415.31 27715 1,011.31 960.74 1,104.85 # 27605 195.22 185.46 213.28 27720 839.35 797.38 916.99 27606 286.62 272.29 313.13 27722 835.98 794.18 913.31 27607 576.75 547.91 630.10 27724 1,220.08 1,159.08 1,332.94 27610 622.44 591.32 680.02 27725 1,134.57 1,077.84 1,239.52 27612 541.84 514.75 591.96 27726 845.80 803.51 924.04 27613 230.40 218.88 251.71 27727 978.46 929.54 1,068.97 # 27613 155.42 147.65 169.80 27730 555.33 527.56 606.69 27614 530.12 503.61 579.15 27732 396.16 376.35 432.80 # 27614 392.80 373.16 429.13 27734 597.46 567.59 652.73 27615 843.32 801.15 921.32 27740 676.70 642.87 739.30 27618 457.76 434.87 500.10 27742 622.33 591.21 679.89 # 27618 359.61 341.63 392.87 27745 722.23 686.12 789.04 27619 734.72 697.98 802.68 27750 317.80 301.91 347.20 # 27619 560.32 532.30 612.15 # 27750 286.21 271.90 312.69 27620 444.58 422.35 485.70 27752 503.53 478.35 550.10 27625 572.94 544.29 625.93 # 27752 465.20 441.94 508.23 27626 615.23 584.47 672.14 27756 539.83 512.84 589.77 27630 513.26 487.60 560.74 27758 842.66 800.53 920.61 # 27630 358.24 340.33 391.38 27759 955.07 907.32 1,043.42 27635 567.34 538.97 619.82 27760 307.43 292.06 335.87 27637 713.55 677.87 779.55 # 27760 271.62 258.04 296.75 27638 745.59 708.31 814.56 27762 454.31 431.59 496.33 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 20 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 27762 414.71 393.97 453.07 # 28003 541.79 514.70 591.91 27766 585.74 556.45 639.92 28005 592.79 563.15 647.62 27767 245.86 233.57 268.61 28008 394.75 375.01 431.26 # 27767 247.12 234.76 269.97 # 28008 299.55 284.57 327.26 27768 373.57 354.89 408.12 28010 218.57 207.64 238.79 27769 637.47 605.60 696.44 # 28010 207.62 197.24 226.83 27780 273.68 260.00 299.00 28011 308.75 293.31 337.31 # 27780 241.66 229.58 264.02 # 28011 292.74 278.10 319.82 27781 391.62 372.04 427.85 28020 474.45 450.73 518.34 # 27781 360.45 342.43 393.79 # 28020 355.24 337.48 388.10 27784 638.44 606.52 697.50 28022 433.41 411.74 473.50 27786 291.42 276.85 318.38 # 28022 329.36 312.89 359.82 # 27786 254.35 241.63 277.87 28024 415.08 394.33 453.48 27788 398.51 378.58 435.37 # 28024 315.24 299.48 344.40 # 27788 361.86 343.77 395.34 28035 471.48 447.91 515.10 27792 652.36 619.74 712.70 # 28035 355.64 337.86 388.54 27808 305.74 290.45 334.02 28043 315.74 299.95 344.94 # 27808 267.83 254.44 292.61 # 28043 258.87 245.93 282.82 27810 445.82 423.53 487.06 28045 441.14 419.08 481.94 # 27810 404.54 384.31 441.96 # 28045 324.03 307.83 354.00 27814 741.77 704.68 810.38 28046 800.20 760.19 874.22 27816 289.49 275.02 316.27 # 28046 654.87 622.13 715.45 # 27816 254.95 242.20 278.53 28050 412.72 392.08 450.89 27818 460.62 437.59 503.23 # 28050 308.25 292.84 336.77 # 27818 415.13 394.37 453.53 28052 386.44 367.12 422.19 27822 827.20 785.84 903.72 # 28052 282.82 268.68 308.98 27823 936.21 889.40 1,022.81 28054 362.80 344.66 396.36 27824 284.25 270.04 310.55 # 28054 258.33 245.41 282.22 # 27824 269.92 256.42 294.88 28055 381.13 362.07 416.38 27825 514.16 488.45 561.72 28060 464.25 441.04 507.20 # 27825 466.98 443.63 510.17 # 28060 355.99 338.19 388.92 27826 771.92 733.32 843.32 28062 548.98 521.53 599.76 27827 1,048.42 996.00 1,145.40 # 28062 412.07 391.47 450.19 27828 1,236.84 1,175.00 1,351.25 28070 460.97 437.92 503.61 27829 610.16 579.65 666.60 # 28070 351.02 333.47 383.49 27830 324.81 308.57 354.86 28072 452.78 430.14 494.66 # 27830 302.49 287.37 330.48 # 28072 343.26 326.10 375.02 27831 357.43 339.56 390.49 28080 440.13 418.12 480.84 27832 642.58 610.45 702.02 # 28080 336.92 320.07 368.08 27840 326.94 310.59 357.18 28086 519.83 493.84 567.92 27842 453.77 431.08 495.74 # 28086 364.81 346.57 398.56 27846 704.13 668.92 769.26 28088 418.59 397.66 457.31 27848 807.79 767.40 882.51 # 28088 298.96 284.01 326.61 27860 168.97 160.52 184.60 28090 419.47 398.50 458.28 27870 997.83 947.94 1,090.13 # 28090 308.27 292.86 336.79 27871 663.39 630.22 724.75 28092 385.34 366.07 420.98 27880 857.70 814.82 937.04 # 28092 276.66 262.83 302.25 27881 851.59 809.01 930.36 28100 556.14 528.33 607.58 27882 605.55 575.27 661.56 # 28100 400.70 380.67 437.77 27884 557.17 529.31 608.71 28102 525.13 498.87 573.70 27886 631.76 600.17 690.20 28103 430.94 409.39 470.80 27888 675.59 641.81 738.08 28104 463.40 440.23 506.26 27889 656.88 624.04 717.65 # 28104 350.93 333.38 383.39 27892 522.59 496.46 570.93 28106 455.79 433.00 497.95 27893 518.95 493.00 566.95 28107 511.53 485.95 558.84 27894 787.51 748.13 860.35 # 28107 377.58 358.70 412.51 28001 249.72 237.23 272.81 28108 388.60 369.17 424.55 # 28001 177.69 168.81 194.13 # 28108 289.61 275.13 316.40 28002 459.09 436.14 501.56 28110 411.49 390.92 449.56 # 28002 368.10 349.70 402.16 # 28110 288.06 273.66 314.71 28003 631.09 599.54 689.47 28111 472.95 449.30 516.70 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 21 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 28111 335.63 318.85 366.68 28234 359.86 341.87 393.15 28112 445.51 423.23 486.71 # 28234 264.24 251.03 288.68 # 28112 315.34 299.57 344.51 28238 626.21 594.90 684.14 28113 521.27 495.21 569.49 # 28238 492.67 468.04 538.25 # 28113 405.43 385.16 442.93 28240 397.08 377.23 433.81 28114 961.51 913.43 1,050.44 # 28240 301.45 286.38 329.34 # 28114 785.85 746.56 858.54 28250 503.92 478.72 550.53 28116 674.77 641.03 737.18 # 28250 393.97 374.27 430.41 # 28116 554.29 526.58 605.57 28260 618.55 587.62 675.76 28118 527.11 500.75 575.86 # 28260 509.44 483.97 556.57 # 28118 404.53 384.30 441.95 28261 889.22 844.76 971.47 28119 471.30 447.74 514.90 # 28261 770.43 731.91 841.70 # 28119 358.83 340.89 392.02 28262 1,265.38 1,202.11 1,382.43 28120 537.63 510.75 587.36 # 28262 1,087.61 1,033.23 1,188.21 # 28120 390.20 370.69 426.29 28264 782.08 742.98 854.43 28122 607.06 576.71 663.22 # 28264 680.56 646.53 743.51 # 28122 496.27 471.46 542.18 28270 429.74 408.25 469.49 28124 430.60 409.07 470.43 # 28270 332.43 315.81 363.18 # 28124 332.87 316.23 363.66 28272 354.47 336.75 387.26 28126 347.95 330.55 380.13 # 28272 259.27 246.31 283.26 # 28126 252.75 240.11 276.13 28280 483.87 459.68 528.63 28130 623.16 592.00 680.80 # 28280 367.61 349.23 401.61 28140 581.76 552.67 635.57 28285 418.45 397.53 457.16 # 28140 452.02 429.42 493.83 # 28285 317.35 301.48 346.70 28150 391.77 372.18 428.01 28286 411.22 390.66 449.26 # 28150 287.73 273.34 314.34 # 28286 305.91 290.61 334.20 28153 361.08 343.03 394.48 28288 522.10 496.00 570.40 # 28153 257.03 244.18 280.81 # 28288 417.63 396.75 456.26 28160 371.94 353.34 406.34 28289 671.32 637.75 733.41 # 28160 274.64 260.91 300.05 # 28289 538.21 511.30 588.00 28171 597.34 567.47 652.59 28290 522.02 495.92 570.31 28173 682.98 648.83 746.15 # 28290 400.70 380.67 437.77 # 28173 546.08 518.78 596.60 28292 697.16 662.30 761.65 28175 501.00 475.95 547.34 # 28292 568.26 539.85 620.83 # 28175 384.74 365.50 420.33 28293 939.77 892.78 1,026.70 28190 229.19 217.73 250.39 # 28293 682.81 648.67 745.97 # 28190 132.72 126.08 144.99 28294 680.11 646.10 743.02 28192 433.64 411.96 473.75 # 28294 523.83 497.64 572.29 # 28192 320.75 304.71 350.42 28296 723.81 687.62 790.76 28193 490.03 465.53 535.36 # 28296 565.00 536.75 617.26 # 28193 376.71 357.87 411.55 28297 763.09 724.94 833.68 28200 427.47 406.10 467.02 # 28297 598.39 568.47 653.74 # 28200 317.95 302.05 347.36 28298 649.81 617.32 709.92 28202 577.89 549.00 631.35 # 28298 503.64 478.46 550.23 # 28202 439.73 417.74 480.40 28299 832.67 791.04 909.70 28208 408.80 388.36 446.61 # 28299 674.28 640.57 736.66 # 28208 303.06 287.91 331.10 28300 646.12 613.81 705.88 28210 532.09 505.49 581.31 28302 643.33 611.16 702.83 # 28210 408.25 387.84 446.02 28304 720.39 684.37 787.03 28220 405.02 384.77 442.49 # 28304 579.69 550.71 633.32 # 28220 308.55 293.12 337.09 28305 660.75 627.71 721.87 28222 468.60 445.17 511.95 28306 546.03 518.73 596.54 # 28222 369.19 350.73 403.34 # 28306 394.38 374.66 430.86 28225 355.76 337.97 388.67 28307 670.47 636.95 732.49 # 28225 257.19 244.33 280.98 # 28307 445.53 423.25 486.74 28226 417.96 397.06 456.62 28308 489.72 465.23 535.01 # 28226 319.39 303.42 348.93 # 28308 359.98 341.98 393.28 28230 391.50 371.93 427.72 28309 862.22 819.11 941.98 # 28230 298.83 283.89 326.47 28310 486.36 462.04 531.35 28232 349.33 331.86 381.64 # 28310 353.24 335.58 385.92 # 28232 254.97 242.22 278.55 28312 444.23 422.02 485.32 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 22 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 28312 318.70 302.77 348.19 28540 187.43 178.06 204.77 28313 457.48 434.61 499.80 # 28540 178.16 169.25 194.64 # 28313 370.70 352.17 405.00 28545 217.59 206.71 237.72 28315 428.47 407.05 468.11 # 28545 204.53 194.30 223.45 # 28315 322.74 306.60 352.59 28546 441.94 419.84 482.82 28320 616.62 585.79 673.66 # 28546 295.35 280.58 322.67 28322 720.76 684.72 787.43 28555 788.22 748.81 861.13 # 28322 567.85 539.46 620.38 # 28555 604.13 573.92 660.01 28340 569.21 540.75 621.86 28570 168.05 159.65 183.60 # 28340 438.21 416.30 478.75 # 28570 153.73 146.04 167.95 28341 647.92 615.52 707.85 28575 302.53 287.40 330.51 # 28341 515.22 489.46 562.88 # 28575 287.78 273.39 314.40 28344 417.15 396.29 455.73 28576 345.73 328.44 377.71 # 28344 299.20 284.24 326.88 28585 804.50 764.28 878.92 28345 517.18 491.32 565.02 # 28585 676.45 642.63 739.02 # 28345 404.29 384.08 441.69 28600 196.68 186.85 214.88 28360 918.86 872.92 1,003.86 # 28600 180.25 171.24 196.93 28400 232.72 221.08 254.24 28605 253.81 241.12 277.29 # 28400 211.23 200.67 230.77 # 28605 240.75 228.71 263.02 28405 373.40 354.73 407.94 28606 377.91 359.01 412.86 # 28405 353.18 335.52 385.85 28615 732.99 696.34 800.79 28406 511.06 485.51 558.34 28630 135.94 129.14 148.51 28415 1,114.70 1,058.97 1,217.82 # 28630 103.93 98.73 113.54 28420 1,156.99 1,099.14 1,264.01 28635 163.56 155.38 178.69 28430 218.72 207.78 238.95 # 28635 133.23 126.57 145.56 # 28430 189.66 180.18 207.21 28636 280.44 266.42 306.38 28435 298.63 283.70 326.26 # 28636 205.04 194.79 224.01 # 28435 280.52 266.49 306.46 28645 543.06 515.91 593.30 28436 410.27 389.76 448.22 # 28645 429.32 407.85 469.03 28445 1,034.51 982.78 1,130.20 28660 100.00 95.00 109.25 28446 1,100.87 1,045.83 1,202.70 # 28660 79.36 75.39 86.70 28450 201.58 191.50 220.23 28665 142.04 134.94 155.18 # 28450 177.57 168.69 193.99 # 28665 131.51 124.93 143.67 28455 270.23 256.72 295.23 28666 195.73 185.94 213.83 # 28455 256.75 243.91 280.50 28675 521.90 495.81 570.18 28456 271.97 258.37 297.13 # 28675 362.25 344.14 395.76 28465 585.59 556.31 639.76 28705 1,258.78 1,195.84 1,375.22 28470 200.80 190.76 219.37 28715 935.54 888.76 1,022.07 # 28470 177.21 168.35 193.60 28725 777.49 738.62 849.41 28475 249.74 237.25 272.84 28730 805.61 765.33 880.13 # 28475 234.15 222.44 255.81 28735 768.54 730.11 839.63 28476 329.04 312.59 359.48 28737 681.24 647.18 744.26 28485 502.83 477.69 549.34 28740 801.29 761.23 875.41 28490 128.52 122.09 140.40 # 28740 605.83 575.54 661.87 # 28490 111.67 106.09 122.00 28750 794.23 754.52 867.70 28495 158.57 150.64 173.24 # 28750 580.66 551.63 634.37 # 28495 143.83 136.64 157.14 28755 462.73 439.59 505.53 28496 421.17 400.11 460.13 # 28755 330.88 314.34 361.49 # 28496 221.50 210.43 241.99 28760 709.06 673.61 774.65 28505 611.42 580.85 667.98 # 28760 560.37 532.35 612.20 # 28505 446.29 423.98 487.58 28800 554.20 526.49 605.46 28510 109.99 104.49 120.16 28805 702.23 667.12 767.19 # 28510 108.30 102.89 118.32 28810 425.80 404.51 465.19 28515 142.80 135.66 156.01 28820 503.73 478.54 550.32 # 28515 134.37 127.65 146.80 # 28820 338.18 321.27 369.46 28525 528.58 502.15 577.47 28825 437.80 415.91 478.30 # 28525 362.61 344.48 396.15 # 28825 279.41 265.44 305.26 28530 105.08 99.83 114.80 28890 342.33 325.21 373.99 # 28530 99.19 94.23 108.36 # 28890 215.96 205.16 235.93 28531 386.03 366.73 421.74 29000 235.24 223.48 257.00 # 28531 189.73 180.24 207.28 # 29000 159.42 151.45 174.17 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 23 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 29010 244.24 232.03 266.83 # 29365 83.79 79.60 91.54 # 29010 154.52 146.79 168.81 29405 84.32 80.10 92.12 29015 228.29 216.88 249.41 # 29405 61.99 58.89 67.72 # 29015 156.26 148.45 170.72 29425 90.44 85.92 98.81 29020 227.17 215.81 248.18 # 29425 68.12 64.71 74.42 # 29020 139.13 132.17 152.00 29435 110.75 105.21 120.99 29025 245.34 233.07 268.03 # 29435 82.53 78.40 90.16 # 29025 170.36 161.84 186.12 29440 49.80 47.31 54.41 29035 222.40 211.28 242.97 # 29440 32.53 30.90 35.54 # 29035 132.67 126.04 144.95 29445 139.08 132.13 151.95 29040 206.48 196.16 225.58 # 29445 107.06 101.71 116.97 # 29040 145.40 138.13 158.85 29450 142.73 135.59 155.93 29044 241.02 228.97 263.32 # 29450 119.98 113.98 131.08 # 29044 153.40 145.73 167.59 29505 73.39 69.72 80.18 29046 256.50 243.68 280.23 # 29505 44.75 42.51 48.89 # 29046 178.15 169.24 194.63 29515 65.58 62.30 71.65 29049 84.78 80.54 92.62 # 29515 46.62 44.29 50.93 # 29049 57.40 54.53 62.71 29520 50.90 48.36 55.61 29055 191.37 181.80 209.07 # 29520 37.00 35.15 40.42 # 29055 126.08 119.78 137.75 29530 51.00 48.45 55.72 29058 108.60 103.17 118.65 # 29530 35.42 33.65 38.70 # 29058 78.69 74.76 85.97 29540 39.28 37.32 42.92 29065 88.79 84.35 97.00 # 29540 32.12 30.51 35.09 # 29065 64.78 61.54 70.77 29550 38.16 36.25 41.69 29075 82.63 78.50 90.28 # 29550 29.74 28.25 32.49 # 29075 58.20 55.29 63.58 29580 49.15 46.69 53.69 29085 87.23 82.87 95.30 # 29580 34.83 33.09 38.05 # 29085 61.53 58.45 67.22 29590 51.56 48.98 56.33 29086 66.16 62.85 72.28 # 29590 39.77 37.78 43.45 # 29086 45.10 42.85 49.28 29700 60.33 57.31 65.91 29105 81.99 77.89 89.57 # 29700 32.53 30.90 35.54 # 29105 55.03 52.28 60.12 29705 62.87 59.73 68.69 29125 63.75 60.56 69.64 # 29705 45.18 42.92 49.36 # 29125 39.31 37.34 42.94 29710 111.49 105.92 121.81 29126 74.94 71.19 81.87 # 29710 77.79 73.90 84.99 # 29126 47.98 45.58 52.42 29715 84.66 80.43 92.49 29130 37.63 35.75 41.11 # 29715 52.22 49.61 57.05 # 29130 26.26 24.95 28.69 29720 75.47 71.70 82.46 29131 47.11 44.75 51.46 # 29720 42.20 40.09 46.10 # 29131 29.42 27.95 32.14 29730 61.35 58.28 67.02 29200 50.86 48.32 55.57 # 29730 43.23 41.07 47.23 # 29200 37.38 35.51 40.84 29740 89.28 84.82 97.54 29220 51.74 49.15 56.52 # 29740 63.59 60.41 69.47 # 29220 38.68 36.75 42.26 29750 93.52 88.84 102.17 29240 57.98 55.08 63.34 # 29750 72.04 68.44 78.71 # 29240 41.97 39.87 45.85 29800 501.43 476.36 547.81 29260 49.82 47.33 54.43 29804 616.08 585.28 673.07 # 29260 34.65 32.92 37.86 29805 449.79 427.30 491.40 29280 48.91 46.46 53.43 29806 1,011.86 961.27 1,105.46 # 29280 32.90 31.26 35.95 29807 987.00 937.65 1,078.30 29305 218.58 207.65 238.80 29819 560.43 532.41 612.27 # 29305 149.07 141.62 162.86 29820 517.15 491.29 564.98 29325 234.72 222.98 256.43 29821 565.02 536.77 617.29 # 29325 164.79 156.55 180.03 29822 550.14 522.63 601.02 29345 126.82 120.48 138.55 29823 600.42 570.40 655.96 # 29345 96.49 91.67 105.42 29824 636.70 604.87 695.60 29355 129.50 123.03 141.48 29825 560.01 532.01 611.81 # 29355 102.96 97.81 112.48 29826 641.11 609.05 700.41 29358 141.75 134.66 154.86 29827 1,041.00 988.95 1,137.29 # 29358 97.94 93.04 107.00 29828 848.77 806.33 927.28 29365 114.12 108.41 124.67 29830 432.91 411.26 472.95 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 24 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 29834 471.37 447.80 514.97 30100 129.97 123.47 141.99 29835 483.14 458.98 527.83 # 30100 66.79 63.45 72.97 29836 553.44 525.77 604.64 30110 210.19 199.68 229.63 29837 505.14 479.88 551.86 # 30110 123.42 117.25 134.84 29838 565.85 537.56 618.19 30115 408.02 387.62 445.76 29840 423.66 402.48 462.85 30117 775.62 736.84 847.37 29843 452.27 429.66 494.11 # 30117 316.88 301.04 346.20 29844 473.24 449.58 517.02 30118 728.82 692.38 796.24 29845 539.92 512.92 589.86 30120 481.11 457.05 525.61 29846 497.29 472.43 543.29 # 30120 428.87 407.43 468.54 29847 515.03 489.28 562.67 30124 267.49 254.12 292.24 29848 465.50 442.23 508.56 30125 593.95 564.25 648.89 29850 519.18 493.22 567.20 30130 361.09 343.04 394.50 29851 891.81 847.22 974.30 30140 407.98 387.58 445.72 29855 751.55 713.97 821.07 30150 769.10 730.65 840.25 29856 956.86 909.02 1,045.37 30160 762.34 724.22 832.85 29860 617.56 586.68 674.68 30200 104.93 99.68 114.63 29861 673.03 639.38 735.29 # 30200 58.17 55.26 63.55 29862 759.00 721.05 829.21 30210 137.21 130.35 149.90 29863 750.05 712.55 819.43 # 30210 94.24 89.53 102.96 29866 999.46 949.49 1,091.91 30220 268.03 254.63 292.82 29867 1,208.64 1,148.21 1,320.44 # 30220 118.49 112.57 129.46 29868 1,615.90 1,535.11 1,765.38 30300 225.94 214.64 246.84 29870 388.89 369.45 424.87 # 30300 117.68 111.80 128.57 29871 487.42 463.05 532.51 30310 198.33 188.41 216.67 29873 493.29 468.63 538.92 30320 448.10 425.70 489.56 29874 508.03 482.63 555.02 30400 1,008.28 957.87 1,101.55 29875 473.66 449.98 517.48 30410 1,216.09 1,155.29 1,328.58 29876 614.06 583.36 670.86 30420 1,316.32 1,250.50 1,438.08 29877 581.66 552.58 635.47 30430 908.64 863.21 992.69 29879 621.45 590.38 678.94 30435 1,189.89 1,130.40 1,299.96 29880 648.84 616.40 708.86 30450 1,530.96 1,454.41 1,672.57 29881 605.27 575.01 661.26 30460 744.15 706.94 812.98 29882 652.61 619.98 712.98 30462 1,491.25 1,416.69 1,629.19 29883 800.72 760.68 874.78 30465 929.38 882.91 1,015.35 29884 579.33 550.36 632.91 30520 555.09 527.34 606.44 29885 701.95 666.85 766.88 30540 659.70 626.72 720.73 29886 592.18 562.57 646.96 30545 924.21 878.00 1,009.70 29887 698.01 663.11 762.58 30560 258.22 245.31 282.11 29888 939.27 892.31 1,026.16 # 30560 133.96 127.26 146.35 29889 1,148.46 1,091.04 1,254.70 30580 590.19 560.68 644.78 29891 659.77 626.78 720.80 # 30580 475.61 451.83 519.60 29892 680.28 646.27 743.21 30600 546.32 519.00 596.85 29893 542.53 515.40 592.71 # 30600 419.95 398.95 458.79 # 29893 406.47 386.15 444.07 30620 590.13 560.62 644.71 29894 494.38 469.66 540.11 30630 590.93 561.38 645.59 29895 481.69 457.61 526.25 30801 218.05 207.15 238.22 29897 504.75 479.51 551.44 # 30801 125.38 119.11 136.98 29898 562.37 534.25 614.39 30802 275.99 262.19 301.52 29899 1,001.98 951.88 1,094.66 # 30802 177.00 168.15 193.37 29900 443.86 421.67 484.92 30901 99.94 94.94 109.18 29901 488.89 464.45 534.12 # 30901 57.39 54.52 62.70 29902 507.76 482.37 554.73 30903 182.43 173.31 199.31 29904 572.85 544.21 625.84 # 30903 75.43 71.66 82.41 29905 618.36 587.44 675.56 30905 228.57 217.14 249.71 29906 651.35 618.78 711.60 # 30905 97.99 93.09 107.05 29907 793.87 754.18 867.31 30906 261.13 248.07 285.28 30000 222.87 211.73 243.49 # 30906 130.12 123.61 142.15 # 30000 110.40 104.88 120.61 30915 543.09 515.94 593.33 30020 209.39 198.92 228.76 30920 774.25 735.54 845.87 # 30020 112.93 107.28 123.37 30930 115.60 109.82 126.29 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 25 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 31000 169.84 161.35 185.55 31400 966.15 917.84 1,055.52 # 31000 99.91 94.91 109.15 31420 789.33 749.86 862.34 31002 194.81 185.07 212.83 31500 103.94 98.74 113.55 31020 470.57 447.04 514.10 31502 33.89 32.20 37.03 # 31020 335.77 318.98 366.83 31505 82.87 78.73 90.54 31030 680.64 646.61 743.60 # 31505 47.48 45.11 51.88 # 31030 495.29 470.53 541.11 31510 206.94 196.59 226.08 31032 540.83 513.79 590.86 # 31510 117.21 111.35 128.05 31040 714.74 679.00 780.85 31511 206.20 195.89 225.27 31050 465.04 441.79 508.06 # 31511 122.38 116.26 133.70 31051 610.65 580.12 667.14 31512 205.36 195.09 224.35 31070 412.41 391.79 450.56 # 31512 126.17 119.86 137.84 31075 741.49 704.42 810.08 31513 129.55 123.07 141.53 31080 969.15 920.69 1,058.79 31515 207.14 196.78 226.30 31081 1,165.36 1,107.09 1,273.15 # 31515 106.04 100.74 115.85 31084 1,089.92 1,035.42 1,190.73 31520 150.42 142.90 164.34 31085 1,171.63 1,113.05 1,280.01 31525 244.82 232.58 267.47 31086 1,059.64 1,006.66 1,157.66 # 31525 155.93 148.13 170.35 31087 1,038.81 986.87 1,134.90 31526 155.32 147.55 169.68 31090 942.80 895.66 1,030.01 31527 187.34 177.97 204.67 31200 529.49 503.02 578.47 31528 139.35 132.38 152.24 31201 694.37 659.65 758.60 31529 159.45 151.48 174.20 31205 824.43 783.21 900.69 31530 194.60 184.87 212.60 31225 1,693.29 1,608.63 1,849.92 31531 210.81 200.27 230.31 31230 1,904.35 1,809.13 2,080.50 31535 186.87 177.53 204.16 31231 186.91 177.56 204.19 31536 209.20 198.74 228.55 # 31231 74.44 70.72 81.33 31540 239.68 227.70 261.86 31233 259.93 246.93 283.97 31541 262.31 249.19 286.57 # 31233 134.40 127.68 146.83 31545 349.90 332.41 382.27 31235 298.13 283.22 325.70 31546 528.99 502.54 577.92 # 31235 159.54 151.56 174.29 31560 308.62 293.19 337.17 31237 321.61 305.53 351.36 31561 336.87 320.03 368.03 # 31237 177.96 169.06 194.42 31570 349.05 331.60 381.34 31238 330.05 313.55 360.58 # 31570 224.79 213.55 245.58 # 31238 193.57 183.89 211.47 31571 247.41 235.04 270.30 31239 634.11 602.40 692.76 31575 115.72 109.93 126.42 31240 158.59 150.66 173.26 # 31575 74.86 71.12 81.79 31254 271.03 257.48 296.10 31576 221.77 210.68 242.28 31255 399.83 379.84 436.82 # 31576 119.83 113.84 130.92 31256 196.94 187.09 215.15 31577 240.29 228.28 262.52 31267 316.42 300.60 345.69 # 31577 146.77 139.43 160.34 31276 503.31 478.14 549.86 31578 277.17 263.31 302.81 31287 230.82 219.28 252.17 # 31578 163.02 154.87 178.10 31288 267.38 254.01 292.11 31579 221.57 210.49 242.06 31290 1,111.16 1,055.60 1,213.94 # 31579 136.90 130.06 149.57 31291 1,171.44 1,112.87 1,279.80 31580 1,145.02 1,087.77 1,250.94 31292 962.82 914.68 1,051.88 31582 1,844.18 1,751.97 2,014.77 31293 1,047.72 995.33 1,144.63 31584 1,443.17 1,371.01 1,576.66 31294 1,203.33 1,143.16 1,314.63 31587 916.99 871.14 1,001.81 31300 1,188.52 1,129.09 1,298.45 31588 1,075.95 1,022.15 1,175.47 31320 634.57 602.84 693.27 31590 879.82 835.83 961.20 31360 1,815.60 1,724.82 1,983.54 31595 741.54 704.46 810.13 31365 2,272.44 2,158.82 2,482.64 31600 381.41 362.34 416.69 31367 2,010.21 1,909.70 2,196.16 31601 249.15 236.69 272.19 31368 2,265.20 2,151.94 2,474.73 31603 214.26 203.55 234.08 31370 1,908.18 1,812.77 2,084.69 31605 174.54 165.81 190.68 31375 1,793.29 1,703.63 1,959.17 31610 674.41 640.69 736.79 31380 1,775.87 1,687.08 1,940.14 31611 511.43 485.86 558.74 31382 1,937.72 1,840.83 2,116.95 31612 79.00 75.05 86.31 31390 2,552.32 2,424.70 2,788.41 # 31612 45.72 43.43 49.94 31395 2,739.60 2,602.62 2,993.01 31613 424.77 403.53 464.06 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 26 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 31614 688.94 654.49 752.66 # 31830 325.41 309.14 355.51 31615 180.26 171.25 196.94 32035 667.42 634.05 729.16 # 31615 122.55 116.42 133.88 32036 723.50 687.33 790.43 31620 296.06 281.26 323.45 32095 597.11 567.25 652.34 # 31620 69.01 65.56 75.39 32100 922.79 876.65 1,008.15 31622 328.94 312.49 359.36 32110 1,380.35 1,311.33 1,508.03 # 31622 140.64 133.61 153.65 32120 822.88 781.74 899.00 31623 362.49 344.37 396.03 32124 873.39 829.72 954.18 # 31623 142.18 135.07 155.33 32140 935.48 888.71 1,022.02 31624 335.53 318.75 366.56 32141 1,349.01 1,281.56 1,473.79 # 31624 142.18 135.07 155.33 32150 942.89 895.75 1,030.11 31625 356.92 339.07 389.93 32151 964.47 916.25 1,053.69 # 31625 165.68 157.40 181.01 32160 713.39 677.72 779.38 31628 428.33 406.91 467.95 32200 1,054.22 1,001.51 1,151.74 # 31628 184.43 175.21 201.49 32201 996.52 946.69 1,088.69 31629 696.38 661.56 760.79 # 32201 199.10 189.15 217.52 # 31629 196.79 186.95 214.99 32215 764.26 726.05 834.96 31630 201.23 191.17 219.85 32220 1,523.14 1,446.98 1,664.03 31631 224.45 213.23 245.21 32225 942.00 894.90 1,029.14 31632 75.26 71.50 82.23 32310 873.58 829.90 954.39 # 31632 51.67 49.09 56.45 32320 1,516.20 1,440.39 1,656.45 31633 89.30 84.84 97.57 32400 152.59 144.96 166.70 # 31633 64.03 60.83 69.95 # 32400 86.04 81.74 94.00 31635 369.50 351.03 403.68 32402 538.79 511.85 588.63 # 31635 185.00 175.75 202.11 32405 97.14 92.28 106.12 31636 219.94 208.94 240.28 # 32405 96.30 91.49 105.21 31637 77.43 73.56 84.59 32420 106.72 101.38 116.59 31638 245.65 233.37 268.38 32421 169.56 161.08 185.24 31640 256.07 243.27 279.76 # 32421 74.36 70.64 81.24 31641 251.20 238.64 274.44 32422 206.10 195.80 225.17 31643 171.34 162.77 187.19 # 32422 121.85 115.76 133.12 31645 319.09 303.14 348.61 32440 1,530.11 1,453.60 1,671.64 # 31645 155.23 147.47 169.59 32442 2,724.86 2,588.62 2,976.91 31646 291.70 277.12 318.69 32445 3,036.04 2,884.24 3,316.88 # 31646 135.00 128.25 147.49 32480 1,442.08 1,369.98 1,575.48 31656 351.14 333.58 383.62 32482 1,537.17 1,460.31 1,679.36 # 31656 109.77 104.28 119.92 32484 1,387.10 1,317.75 1,515.41 31715 52.32 49.70 57.16 32486 2,138.27 2,031.36 2,336.06 31717 372.89 354.25 407.39 32488 2,179.28 2,070.32 2,380.87 # 31717 107.51 102.13 117.45 32491 1,422.55 1,351.42 1,554.13 31720 50.40 47.88 55.06 32500 1,401.47 1,331.40 1,531.11 31725 91.19 86.63 99.62 32501 238.16 226.25 260.19 31730 691.04 656.49 754.96 32503 1,771.10 1,682.55 1,934.93 # 31730 139.21 132.25 152.09 32504 2,017.42 1,916.55 2,204.03 31750 1,282.24 1,218.13 1,400.85 32540 1,527.77 1,451.38 1,669.09 31755 1,641.70 1,559.62 1,793.56 32550 889.26 844.80 971.52 31760 1,309.13 1,243.67 1,430.22 # 32550 219.90 208.91 240.25 31766 1,736.53 1,649.70 1,897.16 32551 172.98 164.33 188.98 31770 1,273.83 1,210.14 1,391.66 32560 323.55 307.37 353.48 31775 1,367.24 1,298.88 1,493.71 # 32560 107.88 102.49 117.86 31780 1,133.19 1,076.53 1,238.01 32601 301.17 286.11 329.03 31781 1,363.09 1,294.94 1,489.18 32602 326.89 310.55 357.13 31785 1,041.71 989.62 1,138.06 32603 419.40 398.43 458.19 31786 1,433.12 1,361.46 1,565.68 32604 470.46 446.94 513.98 31800 675.00 641.25 737.44 32605 378.97 360.02 414.02 31805 788.58 749.15 861.52 32606 452.69 430.06 494.57 31820 408.59 388.16 446.38 32650 663.70 630.52 725.10 # 31820 311.71 296.12 340.54 32651 1,002.40 952.28 1,095.12 31825 570.22 541.71 622.97 32652 1,509.58 1,434.10 1,649.22 # 31825 459.43 436.46 501.93 32653 971.76 923.17 1,061.65 31830 413.03 392.38 451.24 32654 1,065.69 1,012.41 1,164.27 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 27 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 32655 897.82 852.93 980.87 33226 491.00 466.45 536.42 32656 795.00 755.25 868.54 33233 256.72 243.88 280.46 32657 781.82 742.73 854.14 33234 500.86 475.82 547.19 32658 715.32 679.55 781.48 33235 653.23 620.57 713.66 32659 728.25 691.84 795.62 33236 768.61 730.18 839.71 32660 1,019.94 968.94 1,114.28 33237 844.90 802.66 923.06 32661 797.70 757.82 871.49 33238 919.56 873.58 1,004.62 32662 894.97 850.22 977.75 33240 476.51 452.68 520.58 32663 1,336.03 1,269.23 1,459.61 33241 241.00 228.95 263.29 32664 828.89 787.45 905.57 33243 1,325.59 1,259.31 1,448.21 32665 1,140.98 1,083.93 1,246.52 33244 883.48 839.31 965.21 32800 888.27 843.86 970.44 33249 920.57 874.54 1,005.72 32810 864.45 821.23 944.41 33250 1,427.93 1,356.53 1,560.01 32815 2,403.14 2,282.98 2,625.43 33251 1,557.40 1,479.53 1,701.46 32820 1,308.82 1,243.38 1,429.89 33254 1,308.19 1,242.78 1,429.20 32851 2,558.36 2,430.44 2,795.01 33255 1,573.53 1,494.85 1,719.08 32852 2,862.93 2,719.78 3,127.75 33256 1,875.43 1,781.66 2,048.91 32853 3,054.03 2,901.33 3,336.53 33257 582.34 553.22 636.20 32854 3,311.39 3,145.82 3,617.69 33258 656.64 623.81 717.38 32855 254.49 241.77 278.04 33259 859.43 816.46 938.93 32856 307.04 291.69 335.44 33261 1,570.48 1,491.96 1,715.75 32900 1,298.05 1,233.15 1,418.12 33265 1,308.19 1,242.78 1,429.20 32905 1,291.64 1,227.06 1,411.12 33266 1,784.87 1,695.63 1,949.97 32906 1,591.52 1,511.94 1,738.73 33282 339.65 322.67 371.07 32940 1,182.15 1,123.04 1,291.50 33284 252.31 239.69 275.64 32960 137.70 130.82 150.44 33300 2,107.66 2,002.28 2,302.62 # 32960 93.05 88.40 101.66 33305 3,442.39 3,270.27 3,760.81 32997 342.68 325.55 374.38 33310 1,138.57 1,081.64 1,243.89 32998 3,162.21 3,004.10 3,454.72 33315 1,425.51 1,354.23 1,557.36 # 32998 286.39 272.07 312.88 33320 1,027.60 976.22 1,122.65 33010 118.09 112.19 129.02 33321 1,169.28 1,110.82 1,277.44 33011 120.91 114.86 132.09 33322 1,326.05 1,259.75 1,448.71 33015 517.18 491.32 565.02 33330 1,351.05 1,283.50 1,476.03 33020 833.18 791.52 910.25 33332 1,337.78 1,270.89 1,461.52 33025 772.22 733.61 843.65 33335 1,813.94 1,723.24 1,981.73 33030 1,230.26 1,168.75 1,344.06 33400 2,157.76 2,049.87 2,357.35 33031 1,361.88 1,293.79 1,487.86 33401 1,432.47 1,360.85 1,564.98 33050 954.18 906.47 1,042.44 33403 1,529.30 1,452.84 1,670.77 33120 1,500.81 1,425.77 1,639.64 33404 1,744.69 1,657.46 1,906.08 33130 1,313.26 1,247.60 1,434.74 33405 2,254.75 2,142.01 2,463.31 33140 1,486.87 1,412.53 1,624.41 33406 2,728.62 2,592.19 2,981.02 33141 156.30 148.49 170.76 33410 2,401.07 2,281.02 2,623.17 33202 751.51 713.93 821.02 33411 3,095.60 2,940.82 3,381.94 33203 770.10 731.60 841.34 33412 2,441.40 2,319.33 2,667.23 33206 464.36 441.14 507.31 33413 3,148.25 2,990.84 3,439.47 33207 495.79 471.00 541.65 33414 2,062.60 1,959.47 2,253.39 33208 530.81 504.27 579.91 33415 1,910.52 1,814.99 2,087.24 33210 178.51 169.58 195.02 33416 1,930.99 1,834.44 2,109.61 33211 182.05 172.95 198.89 33417 1,641.49 1,559.42 1,793.33 33212 347.60 330.22 379.75 33420 1,323.17 1,257.01 1,445.56 33213 395.50 375.73 432.09 33422 1,644.95 1,562.70 1,797.11 33214 496.20 471.39 542.10 33425 2,451.14 2,328.58 2,677.87 33215 316.67 300.84 345.97 33426 2,301.15 2,186.09 2,514.00 33216 391.24 371.68 427.43 33427 2,431.00 2,309.45 2,655.87 33217 389.31 369.84 425.32 33430 2,622.18 2,491.07 2,864.73 33218 404.92 384.67 442.37 33460 2,158.36 2,050.44 2,358.01 33220 406.34 386.02 443.92 33463 2,727.32 2,590.95 2,979.59 33222 362.86 344.72 396.43 33464 2,245.89 2,133.60 2,453.64 33223 432.54 410.91 472.55 33465 2,485.16 2,360.90 2,715.04 33224 508.93 483.48 556.00 33468 1,839.11 1,747.15 2,009.22 33225 455.08 432.33 497.18 33470 1,142.95 1,085.80 1,248.67 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 28 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 33471 1,322.41 1,256.29 1,444.73 33694 1,868.20 1,774.79 2,041.01 33472 1,315.14 1,249.38 1,436.79 33697 2,058.84 1,955.90 2,249.29 33474 1,924.91 1,828.66 2,102.96 33702 1,512.34 1,436.72 1,652.23 33475 2,216.43 2,105.61 2,421.45 33710 1,686.90 1,602.56 1,842.94 33476 1,435.17 1,363.41 1,567.92 33720 1,515.38 1,439.61 1,655.55 33478 1,548.48 1,471.06 1,691.72 33722 1,535.65 1,458.87 1,677.70 33496 1,629.67 1,548.19 1,780.42 33724 1,487.61 1,413.23 1,625.21 33500 1,529.56 1,453.08 1,671.04 33726 1,959.17 1,861.21 2,140.39 33501 1,056.37 1,003.55 1,154.08 33730 1,935.64 1,838.86 2,114.69 33502 1,252.57 1,189.94 1,368.43 33732 1,631.83 1,550.24 1,782.78 33503 1,270.87 1,207.33 1,388.43 33735 1,223.24 1,162.08 1,336.39 33504 1,427.02 1,355.67 1,559.02 33736 1,412.59 1,341.96 1,543.25 33505 1,951.85 1,854.26 2,132.40 33737 1,274.34 1,210.62 1,392.21 33506 1,991.05 1,891.50 2,175.23 33750 1,193.64 1,133.96 1,304.05 33507 1,701.72 1,616.63 1,859.12 33755 1,205.22 1,144.96 1,316.70 33508 15.77 14.98 17.23 33762 1,249.22 1,186.76 1,364.77 33510 1,926.30 1,829.99 2,104.49 33764 1,252.06 1,189.46 1,367.88 33511 2,089.48 1,985.01 2,282.76 33766 1,325.99 1,259.69 1,448.64 33512 2,328.43 2,212.01 2,543.81 33767 1,389.95 1,320.45 1,518.52 33513 2,394.95 2,275.20 2,616.48 33768 400.46 380.44 437.51 33514 2,509.05 2,383.60 2,741.14 33770 2,050.14 1,947.63 2,239.77 33516 2,605.25 2,474.99 2,846.24 33771 2,077.29 1,973.43 2,269.44 33517 174.09 165.39 190.20 33774 1,775.41 1,686.64 1,939.64 33518 372.57 353.94 407.03 33775 1,787.03 1,697.68 1,952.33 33519 500.56 475.53 546.86 33776 1,867.78 1,774.39 2,040.55 33521 610.47 579.95 666.94 33777 1,849.68 1,757.20 2,020.78 33522 700.20 665.19 764.97 33778 2,295.87 2,181.08 2,508.24 33523 803.23 763.07 877.53 33779 2,131.33 2,024.76 2,328.47 33530 470.85 447.31 514.41 33780 2,270.18 2,156.67 2,480.17 33533 1,884.36 1,790.14 2,058.66 33781 2,151.95 2,044.35 2,351.00 33534 2,168.12 2,059.71 2,368.67 33786 2,230.17 2,118.66 2,436.46 33535 2,383.83 2,264.64 2,604.34 33788 1,467.12 1,393.76 1,602.82 33536 2,545.66 2,418.38 2,781.14 33800 970.23 921.72 1,059.98 33542 2,384.94 2,265.69 2,605.54 33802 1,045.85 993.56 1,142.59 33545 2,832.86 2,691.22 3,094.90 33803 1,117.83 1,061.94 1,221.23 33548 2,802.58 2,662.45 3,061.82 33813 1,226.80 1,165.46 1,340.28 33572 227.58 216.20 248.63 33814 1,493.20 1,418.54 1,631.32 33600 1,670.59 1,587.06 1,825.12 33820 954.22 906.51 1,042.49 33602 1,597.68 1,517.80 1,745.47 33822 989.41 939.94 1,080.93 33606 1,730.70 1,644.17 1,890.80 33824 1,153.87 1,096.18 1,260.61 33608 1,781.55 1,692.47 1,946.34 33840 1,194.85 1,135.11 1,305.38 33610 1,763.84 1,675.65 1,927.00 33845 1,302.34 1,237.22 1,422.80 33611 1,888.11 1,793.70 2,062.76 33851 1,245.22 1,182.96 1,360.40 33612 2,012.08 1,911.48 2,198.20 33852 1,435.31 1,363.54 1,568.07 33615 1,905.08 1,809.83 2,081.30 33853 1,797.34 1,707.47 1,963.59 33617 2,116.59 2,010.76 2,312.37 33860 2,949.19 2,801.73 3,221.99 33619 2,652.38 2,519.76 2,897.72 33861 2,378.73 2,259.79 2,598.76 33641 1,524.60 1,448.37 1,665.63 33863 2,987.09 2,837.74 3,263.40 33645 1,531.69 1,455.11 1,673.38 33864 3,075.45 2,921.68 3,359.93 33647 1,649.49 1,567.02 1,802.07 33870 2,480.27 2,356.26 2,709.70 33660 1,740.24 1,653.23 1,901.21 33875 1,920.74 1,824.70 2,098.41 33665 1,842.32 1,750.20 2,012.73 33877 3,290.31 3,125.79 3,594.66 33670 1,981.76 1,882.67 2,165.07 33880 1,760.76 1,672.72 1,923.63 33675 2,023.84 1,922.65 2,211.05 33881 1,521.28 1,445.22 1,662.00 33676 2,084.92 1,980.67 2,277.77 33883 1,117.86 1,061.97 1,221.27 33677 2,166.75 2,058.41 2,367.17 33884 400.84 380.80 437.92 33681 1,800.45 1,710.43 1,966.99 33886 968.56 920.13 1,058.15 33684 1,826.88 1,735.54 1,995.87 33889 795.99 756.19 869.62 33688 1,778.19 1,689.28 1,942.67 33891 1,026.41 975.09 1,121.35 33690 1,137.33 1,080.46 1,242.53 33910 1,590.20 1,510.69 1,737.29 33692 1,903.00 1,807.85 2,079.03 33915 1,277.08 1,213.23 1,395.21 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 29 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 33916 1,532.94 1,456.29 1,674.73 35002 1,199.74 1,139.75 1,310.71 33917 1,428.48 1,357.06 1,560.62 35005 1,066.91 1,013.56 1,165.59 33920 1,722.40 1,636.28 1,881.72 35011 1,001.98 951.88 1,094.66 33922 1,352.08 1,284.48 1,477.15 35013 1,240.36 1,178.34 1,355.09 33924 282.28 268.17 308.40 35021 1,208.59 1,148.16 1,320.38 33925 1,849.13 1,756.67 2,020.17 35022 1,390.79 1,321.25 1,519.44 33926 2,380.17 2,261.16 2,600.33 35045 969.66 921.18 1,059.36 33933 351.95 334.35 384.50 35081 1,714.57 1,628.84 1,873.17 33935 3,444.69 3,272.46 3,763.33 35082 2,170.50 2,061.98 2,371.28 33944 248.02 235.62 270.96 35091 1,844.66 1,752.43 2,015.29 33945 4,287.11 4,072.75 4,683.66 35092 2,585.13 2,455.87 2,824.25 33960 946.80 899.46 1,034.38 35102 1,861.08 1,768.03 2,033.23 33961 533.97 507.27 583.36 35103 2,241.87 2,129.78 2,449.25 33967 263.60 250.42 287.98 35111 1,387.82 1,318.43 1,516.19 33968 33.69 32.01 36.81 35112 1,682.27 1,598.16 1,837.88 33970 353.92 336.22 386.65 35121 1,660.28 1,577.27 1,813.86 33971 692.96 658.31 757.06 35122 1,950.93 1,853.38 2,131.39 33973 520.14 494.13 568.25 35131 1,409.97 1,339.47 1,540.39 33974 885.50 841.23 967.41 35132 1,702.34 1,617.22 1,859.80 33975 1,065.37 1,012.10 1,163.92 35141 1,124.38 1,068.16 1,228.38 33976 1,194.18 1,134.47 1,304.64 35142 1,338.20 1,271.29 1,461.98 33977 1,193.71 1,134.02 1,304.12 35151 1,266.02 1,202.72 1,383.13 33978 1,326.54 1,260.21 1,449.24 35152 1,469.67 1,396.19 1,605.62 33979 2,354.70 2,236.97 2,572.52 35180 815.03 774.28 890.42 33980 3,466.38 3,293.06 3,787.02 35182 1,695.21 1,610.45 1,852.02 34001 931.56 884.98 1,017.73 35184 1,019.62 968.64 1,113.94 34051 957.89 910.00 1,046.50 35188 866.11 822.80 946.22 34101 612.00 581.40 668.61 35189 1,605.36 1,525.09 1,753.85 34111 611.28 580.72 667.83 35190 751.07 713.52 820.55 34151 1,400.26 1,330.25 1,529.79 35201 940.53 893.50 1,027.53 34201 950.06 902.56 1,037.94 35206 770.69 732.16 841.98 34203 973.58 924.90 1,063.64 35207 705.51 670.23 770.76 34401 1,405.00 1,334.75 1,534.96 35211 1,351.61 1,284.03 1,476.63 34421 737.41 700.54 805.62 35216 1,786.51 1,697.18 1,951.76 34451 1,513.64 1,437.96 1,653.65 35221 1,382.35 1,313.23 1,510.21 34471 1,022.13 971.02 1,116.67 35226 853.35 810.68 932.28 34490 614.14 583.43 670.94 35231 1,167.06 1,108.71 1,275.02 34501 950.02 902.52 1,037.90 35236 977.49 928.62 1,067.91 34502 1,529.42 1,452.95 1,670.89 35241 1,412.91 1,342.26 1,543.60 34510 1,095.52 1,040.74 1,196.85 35246 1,520.17 1,444.16 1,660.78 34520 1,038.26 986.35 1,134.30 35251 1,646.63 1,564.30 1,798.95 34530 976.32 927.50 1,066.63 35256 1,029.76 978.27 1,125.01 34800 1,144.46 1,087.24 1,250.33 35261 1,031.99 980.39 1,127.45 34802 1,249.36 1,186.89 1,364.92 35266 857.77 814.88 937.11 34803 1,280.15 1,216.14 1,398.56 35271 1,347.46 1,280.09 1,472.10 34804 1,246.36 1,184.04 1,361.65 35276 1,415.62 1,344.84 1,546.57 34805 1,179.47 1,120.50 1,288.58 35281 1,572.30 1,493.69 1,717.74 34806 99.90 94.91 109.15 35286 948.96 901.51 1,036.74 34808 207.88 197.49 227.11 35301 1,058.47 1,005.55 1,156.38 34812 345.33 328.06 377.27 35302 1,098.77 1,043.83 1,200.40 34813 239.22 227.26 261.35 35303 1,206.27 1,145.96 1,317.85 34820 493.67 468.99 539.34 35304 1,255.05 1,192.30 1,371.15 34825 705.93 670.63 771.22 35305 1,206.27 1,145.96 1,317.85 34826 205.07 194.82 224.04 35306 448.79 426.35 490.30 34830 1,828.23 1,736.82 1,997.34 35311 1,515.88 1,440.09 1,656.10 34831 1,909.75 1,814.26 2,086.40 35321 902.28 857.17 985.75 34832 1,980.58 1,881.55 2,163.78 35331 1,469.68 1,396.20 1,605.63 34833 618.19 587.28 675.37 35341 1,397.38 1,327.51 1,526.64 34834 282.24 268.13 308.35 35351 1,291.96 1,227.36 1,411.46 34900 913.72 868.03 998.23 35355 1,052.29 999.68 1,149.63 35001 1,146.95 1,089.60 1,253.04 35361 1,589.77 1,510.28 1,736.82 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 30 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 35363 1,703.15 1,617.99 1,860.69 35548 1,213.22 1,152.56 1,325.44 35371 837.11 795.25 914.54 35549 1,323.54 1,257.36 1,445.96 35372 1,002.27 952.16 1,094.98 35551 1,488.39 1,413.97 1,626.07 35390 161.16 153.10 176.07 35556 1,378.63 1,309.70 1,506.16 35400 152.48 144.86 166.59 35558 1,233.49 1,171.82 1,347.59 35450 514.64 488.91 562.25 35560 1,791.46 1,701.89 1,957.17 35452 359.52 341.54 392.77 35563 1,392.03 1,322.43 1,520.79 35454 315.67 299.89 344.87 35565 1,328.90 1,262.46 1,451.83 35456 381.72 362.63 417.02 35566 1,650.25 1,567.74 1,802.90 35458 490.29 465.78 535.65 35571 1,359.32 1,291.35 1,485.05 35459 449.95 427.45 491.57 35572 347.41 330.04 379.55 35460 313.21 297.55 342.18 35583 1,423.75 1,352.56 1,555.44 35470 3,473.63 3,299.95 3,794.94 35585 1,679.12 1,595.16 1,834.43 # 35470 455.01 432.26 497.10 35587 1,406.89 1,336.55 1,537.03 35471 3,863.83 3,670.64 4,221.24 35600 254.85 242.11 278.43 # 35471 541.49 514.42 591.58 35601 1,424.61 1,353.38 1,556.39 35472 2,608.27 2,477.86 2,849.54 35606 1,179.85 1,120.86 1,288.99 # 35472 367.68 349.30 401.70 35612 925.91 879.61 1,011.55 35473 2,460.80 2,337.76 2,688.42 35616 1,121.02 1,064.97 1,224.72 # 35473 322.57 306.44 352.41 35621 1,120.77 1,064.73 1,224.44 35474 3,387.06 3,217.71 3,700.37 35623 1,373.64 1,304.96 1,500.70 # 35474 389.08 369.63 425.07 35626 1,572.61 1,493.98 1,718.08 35475 2,546.57 2,419.24 2,782.13 35631 1,874.95 1,781.20 2,048.38 # 35475 485.01 460.76 529.87 35636 1,654.45 1,571.73 1,807.49 35476 1,939.26 1,842.30 2,118.65 35637 1,693.58 1,608.90 1,850.24 # 35476 310.31 294.79 339.01 35638 1,720.29 1,634.28 1,879.42 35480 582.11 553.00 635.95 35642 1,018.84 967.90 1,113.09 35481 405.03 384.78 442.50 35645 1,036.82 984.98 1,132.73 35482 347.51 330.13 379.65 35646 1,738.50 1,651.58 1,899.32 35483 425.07 403.82 464.39 35647 1,571.43 1,492.86 1,716.79 35484 530.85 504.31 579.96 35650 1,081.87 1,027.78 1,181.95 35485 495.52 470.74 541.35 35651 1,387.31 1,317.94 1,515.63 35490 602.94 572.79 658.71 35654 1,390.46 1,320.94 1,519.08 35491 429.15 407.69 468.84 35656 1,097.96 1,043.06 1,199.52 35492 377.95 359.05 412.91 35661 1,101.18 1,046.12 1,203.04 35493 453.31 430.64 495.24 35663 1,273.70 1,210.02 1,391.52 35494 572.39 543.77 625.34 35665 1,195.07 1,135.32 1,305.62 35495 527.12 500.76 575.87 35666 1,292.96 1,228.31 1,412.56 35500 321.59 305.51 351.34 35671 1,138.65 1,081.72 1,243.98 35501 1,513.62 1,437.94 1,653.63 35681 80.77 76.73 88.24 35506 1,312.73 1,247.09 1,434.15 35682 359.59 341.61 392.85 35508 1,344.99 1,277.74 1,469.40 35683 423.53 402.35 462.70 35509 1,474.89 1,401.15 1,611.32 35685 202.37 192.25 221.09 35510 1,260.52 1,197.49 1,377.11 35686 168.55 160.12 184.14 35511 1,192.83 1,133.19 1,303.17 35691 998.73 948.79 1,091.11 35512 1,235.22 1,173.46 1,349.48 35693 886.17 841.86 968.14 35515 1,348.36 1,280.94 1,473.08 35694 1,043.35 991.18 1,139.86 35516 1,184.73 1,125.49 1,294.31 35695 1,078.18 1,024.27 1,177.91 35518 1,196.60 1,136.77 1,307.29 35697 150.61 143.08 164.54 35521 1,278.72 1,214.78 1,397.00 35700 154.62 146.89 168.92 35522 1,203.55 1,143.37 1,314.88 35701 540.41 513.39 590.40 35523 1,262.94 1,199.79 1,379.76 35721 463.73 440.54 506.62 35525 1,138.49 1,081.57 1,243.81 35741 503.74 478.55 550.33 35526 1,731.00 1,644.45 1,891.12 35761 376.32 357.50 411.13 35531 2,018.72 1,917.78 2,205.45 35800 479.62 455.64 523.99 35533 1,568.35 1,489.93 1,713.42 35820 1,725.26 1,639.00 1,884.85 35536 1,746.42 1,659.10 1,907.97 35840 619.94 588.94 677.28 35537 2,133.54 2,026.86 2,330.89 35860 406.71 386.37 444.33 35538 2,381.55 2,262.47 2,601.84 35870 1,286.86 1,222.52 1,405.90 35539 2,233.29 2,121.63 2,439.87 35875 601.31 571.24 656.93 35540 2,488.77 2,364.33 2,718.98 35876 954.52 906.79 1,042.81 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 31 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 35879 939.79 892.80 1,026.72 36406 17.39 16.52 19.00 35881 1,044.94 992.69 1,141.59 # 36406 8.54 8.11 9.33 35883 1,233.02 1,171.37 1,347.08 36410 19.07 18.12 20.84 35884 1,308.78 1,243.34 1,429.84 # 36410 8.54 8.11 9.33 35901 514.23 488.52 561.80 36420 46.34 44.02 50.62 35903 584.31 555.09 638.35 36425 36.34 34.52 39.70 35905 1,762.80 1,674.66 1,925.86 36430 42.66 40.53 46.61 35907 1,929.84 1,833.35 2,108.35 36440 49.27 46.81 53.83 36000 27.92 26.52 30.50 36450 112.64 107.01 123.06 # 36000 8.96 8.51 9.79 36455 121.96 115.86 133.24 36002 178.86 169.92 195.41 36460 331.26 314.70 361.91 # 36002 109.78 104.29 119.93 36470 147.83 140.44 161.51 36005 373.24 354.58 407.77 # 36470 69.48 66.01 75.91 # 36005 48.46 46.04 52.95 36471 178.56 169.63 195.07 36010 728.78 692.34 796.19 # 36471 96.84 92.00 105.80 # 36010 121.35 115.28 132.57 36475 2,074.76 1,971.02 2,266.67 36011 1,113.94 1,058.24 1,216.98 # 36475 331.24 314.68 361.88 # 36011 157.72 149.83 172.30 36476 414.98 394.23 453.36 36012 951.46 903.89 1,039.47 # 36476 160.97 152.92 175.86 # 36012 177.22 168.36 193.61 36478 1,792.53 1,702.90 1,958.34 36013 938.49 891.57 1,025.31 # 36478 334.61 317.88 365.56 # 36013 126.76 120.42 138.48 36479 422.14 401.03 461.18 36014 931.24 884.68 1,017.38 # 36479 163.50 155.33 178.63 # 36014 152.79 145.15 166.92 36481 356.83 338.99 389.84 36015 1,014.47 963.75 1,108.31 36500 179.69 170.71 196.32 # 36015 171.99 163.39 187.90 36510 144.28 137.07 157.63 36100 600.98 570.93 656.57 # 36510 58.77 55.83 64.20 # 36100 158.68 150.75 173.36 36511 88.46 84.04 96.65 36120 491.64 467.06 537.12 36512 89.30 84.84 97.57 # 36120 98.20 93.29 107.28 36513 90.74 86.20 99.13 36140 562.59 534.46 614.63 36514 639.87 607.88 699.06 # 36140 100.91 95.86 110.24 # 36514 87.20 82.84 95.27 36145 552.66 525.03 603.78 36515 2,417.09 2,296.24 2,640.68 # 36145 98.99 94.04 108.15 # 36515 85.09 80.84 92.97 36160 620.33 589.31 677.71 36516 2,859.44 2,716.47 3,123.94 # 36160 132.96 126.31 145.26 # 36516 61.55 58.47 67.24 36200 745.29 708.03 814.23 36522 1,531.25 1,454.69 1,672.89 # 36200 151.76 144.17 165.80 # 36522 100.29 95.28 109.57 36215 1,282.44 1,218.32 1,401.07 36555 295.17 280.41 322.47 # 36215 239.44 227.47 261.59 # 36555 122.88 116.74 134.25 36216 1,391.16 1,321.60 1,519.84 36556 268.68 255.25 293.54 # 36216 268.97 255.52 293.85 # 36556 117.45 111.58 128.32 36217 2,360.94 2,242.89 2,579.32 36557 953.39 905.72 1,041.58 # 36217 322.55 306.42 352.38 # 36557 293.72 279.03 320.88 36218 222.84 211.70 243.46 36558 935.83 889.04 1,022.40 # 36218 51.40 48.83 56.15 # 36558 283.33 269.16 309.53 36245 1,450.03 1,377.53 1,584.16 36560 1,303.00 1,237.85 1,423.53 # 36245 246.96 234.61 269.80 # 36560 349.73 332.24 382.08 36246 1,399.16 1,329.20 1,528.58 36561 1,312.68 1,247.05 1,434.11 # 36246 269.81 256.32 294.77 # 36561 337.92 321.02 369.17 36247 2,221.99 2,110.89 2,427.52 36563 1,285.55 1,221.27 1,404.46 # 36247 321.35 305.28 351.07 # 36563 352.50 334.88 385.11 36248 188.30 178.89 205.72 36565 1,109.64 1,054.16 1,212.28 # 36248 51.40 48.83 56.15 # 36565 334.13 317.42 365.03 36260 570.94 542.39 623.75 36566 3,132.05 2,975.45 3,421.77 36261 350.07 332.57 382.46 # 36566 357.33 339.46 390.38 36262 268.11 254.70 292.91 36568 350.35 332.83 382.75 36400 25.35 24.08 27.69 # 36568 92.97 88.32 101.57 # 36400 17.35 16.48 18.95 36569 316.02 300.22 345.25 36405 22.63 21.50 24.73 # 36569 93.18 88.52 101.80 # 36405 14.62 13.89 15.97 36570 1,343.59 1,276.41 1,467.87 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 32 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 36570 298.48 283.56 326.09 # 36860 98.56 93.63 107.67 36571 1,413.97 1,343.27 1,544.76 36861 150.11 142.60 163.99 # 36571 305.26 290.00 333.50 36870 2,160.51 2,052.48 2,360.35 36575 183.64 174.46 200.63 # 36870 307.89 292.50 336.38 # 36575 39.15 37.19 42.77 37140 1,317.96 1,252.06 1,439.87 36576 385.09 365.84 420.72 37145 1,429.28 1,357.82 1,561.49 # 36576 186.27 176.96 203.50 37160 1,228.06 1,166.66 1,341.66 36578 552.19 524.58 603.27 37180 1,395.33 1,325.56 1,524.39 # 36578 214.77 204.03 234.63 37181 1,474.71 1,400.97 1,611.12 36580 279.38 265.41 305.22 37182 864.15 820.94 944.08 # 36580 67.49 64.12 73.74 37183 412.58 391.95 450.74 36581 859.89 816.90 939.44 37184 2,872.80 2,729.16 3,138.53 # 36581 199.38 189.41 217.82 # 37184 447.71 425.32 489.12 36582 1,183.87 1,124.68 1,293.38 37185 944.88 897.64 1,032.29 # 36582 293.79 279.10 320.97 # 37185 164.32 156.10 179.52 36583 1,186.67 1,127.34 1,296.44 37186 1,952.46 1,854.84 2,133.07 # 36583 296.17 281.36 323.56 # 37186 248.12 235.71 271.07 36584 276.77 262.93 302.37 37187 2,782.31 2,643.19 3,039.67 # 36584 70.78 67.24 77.33 # 37187 415.77 394.98 454.23 36585 1,229.84 1,168.35 1,343.60 37188 2,400.37 2,280.35 2,622.40 # 36585 276.99 263.14 302.61 # 37188 299.63 284.65 327.35 36589 170.26 161.75 186.01 37195 361.52 343.44 394.96 # 36589 139.08 132.13 151.95 37200 228.45 217.03 249.58 36590 272.62 258.99 297.84 37201 281.05 267.00 307.05 # 36590 195.11 185.35 213.15 37202 338.65 321.72 369.98 36591 23.05 21.90 25.19 37203 1,505.97 1,430.67 1,645.27 36592 28.52 27.09 31.15 # 37203 264.99 251.74 289.50 36593 36.37 34.55 39.73 37204 911.80 866.21 996.14 36595 719.34 683.37 785.88 37205 2,667.11 2,533.75 2,913.81 # 36595 186.89 177.55 204.18 # 37205 444.63 422.40 485.76 36596 158.66 150.73 173.34 37206 1,579.90 1,500.91 1,726.05 # 36596 46.61 44.28 50.92 # 37206 211.70 201.12 231.29 36597 136.65 129.82 149.29 37207 430.97 409.42 470.83 # 36597 62.09 58.99 67.84 37208 207.04 196.69 226.19 36598 128.79 122.35 140.70 37209 112.80 107.16 123.23 # 36598 87.93 83.53 96.06 37210 3,885.19 3,690.93 4,244.57 36600 31.98 30.38 34.94 # 37210 530.84 504.30 579.95 # 36600 14.71 13.97 16.07 37215 1,094.91 1,040.16 1,196.18 36620 48.84 46.40 53.36 37250 109.26 103.80 119.37 36625 101.04 95.99 110.39 37251 81.68 77.60 89.24 36640 118.11 112.20 129.03 37500 692.79 658.15 756.87 36660 69.06 65.61 75.45 37565 670.74 637.20 732.78 36680 60.38 57.36 65.96 37600 702.65 667.52 767.65 36800 159.92 151.92 174.71 37605 799.40 759.43 873.34 36810 210.53 200.00 230.00 37606 529.83 503.34 578.84 36815 145.42 138.15 158.87 37607 373.09 354.44 407.61 36818 677.40 643.53 740.06 37609 296.05 281.25 323.44 36819 786.90 747.56 859.69 # 37609 192.43 182.81 210.23 36820 789.55 750.07 862.58 37615 453.90 431.21 495.89 36821 527.13 500.77 575.89 37616 1,045.08 992.83 1,141.75 36822 380.72 361.68 415.93 37617 1,249.47 1,187.00 1,365.05 36823 1,237.07 1,175.22 1,351.50 37618 368.07 349.67 402.12 36825 573.82 545.13 626.90 37620 650.47 617.95 710.64 36830 652.30 619.69 712.64 37650 502.35 477.23 548.81 36831 453.45 430.78 495.40 37660 1,175.34 1,116.57 1,284.06 36832 576.12 547.31 629.41 37700 251.94 239.34 275.24 36833 649.24 616.78 709.30 37718 401.18 381.12 438.29 36834 605.72 575.43 661.74 37722 469.46 445.99 512.89 36835 449.97 427.47 491.59 37735 624.32 593.10 682.07 36838 1,165.89 1,107.60 1,273.74 37760 610.90 580.36 667.41 36860 179.44 170.47 196.04 37765 444.41 422.19 485.52 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 33 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 37766 537.34 510.47 587.04 39010 787.70 748.32 860.57 37780 257.04 244.19 280.82 39200 858.04 815.14 937.41 37785 360.12 342.11 393.43 39220 1,097.14 1,042.28 1,198.62 # 37785 258.60 245.67 282.52 39400 484.15 459.94 528.93 37788 1,296.94 1,232.09 1,416.90 39501 781.06 742.01 853.31 37790 500.86 475.82 547.19 39502 931.66 885.08 1,017.84 38100 989.54 940.06 1,081.07 39503 5,279.75 5,015.76 5,768.12 38101 1,002.29 952.18 1,095.01 39520 941.20 894.14 1,028.26 38102 240.97 228.92 263.26 39530 892.33 847.71 974.87 38115 1,095.59 1,040.81 1,196.93 39531 942.39 895.27 1,029.56 38120 942.05 894.95 1,029.19 39540 795.17 755.41 868.72 38200 134.88 128.14 147.36 39541 853.78 811.09 932.75 38205 78.00 74.10 85.22 39545 852.59 809.96 931.45 38206 78.42 74.50 85.68 39560 734.19 697.48 802.10 38220 172.73 164.09 188.70 39561 1,133.43 1,076.76 1,238.27 # 38220 58.15 55.24 63.53 40490 120.47 114.45 131.62 38221 190.04 180.54 207.62 # 40490 67.39 64.02 73.62 # 38221 74.20 70.49 81.06 40500 470.00 446.50 513.48 38230 310.58 295.05 339.31 # 40500 341.52 324.44 373.11 38240 120.14 114.13 131.25 40510 456.01 433.21 498.19 38241 120.56 114.53 131.71 # 40510 335.54 318.76 366.57 38242 91.06 86.51 99.49 40520 481.00 456.95 525.49 38300 264.03 250.83 288.45 # 40520 341.99 324.89 373.62 # 38300 170.94 162.39 186.75 40525 527.61 501.23 576.41 38305 429.65 408.17 469.40 40527 624.08 592.88 681.81 38308 406.25 385.94 443.83 40530 524.94 498.69 573.49 38380 529.90 503.41 578.92 # 40530 386.77 367.43 422.54 38381 778.31 739.39 850.30 40650 405.21 384.95 442.69 38382 632.12 600.51 690.59 # 40650 272.10 258.50 297.28 38500 298.34 283.42 325.93 40652 477.26 453.40 521.41 # 38500 228.41 216.99 249.54 # 40652 337.83 320.94 369.08 38505 128.67 122.24 140.58 40654 551.13 523.57 602.11 # 38505 73.07 69.42 79.83 # 40654 402.01 381.91 439.20 38510 477.90 454.01 522.11 40700 873.87 830.18 954.71 # 38510 386.07 366.77 421.79 40701 1,028.31 976.89 1,123.42 38520 424.19 402.98 463.43 40702 808.97 768.52 883.80 38525 380.76 361.72 415.98 40720 953.91 906.21 1,042.14 38530 491.85 467.26 537.35 40761 1,000.59 950.56 1,093.14 38542 400.94 380.89 438.02 40800 187.39 178.02 204.72 38550 435.35 413.58 475.62 # 40800 121.26 115.20 132.48 38555 910.17 864.66 994.36 40801 283.42 269.25 309.64 38562 647.99 615.59 707.93 # 40801 208.02 197.62 227.26 38564 641.11 609.05 700.41 40804 197.10 187.25 215.34 38570 515.72 489.93 563.42 # 40804 123.80 117.61 135.25 38571 792.78 753.14 866.11 40805 304.26 289.05 332.41 38572 901.03 855.98 984.38 # 40805 217.06 206.21 237.14 38700 718.74 682.80 785.22 40806 101.28 96.22 110.65 38720 1,181.23 1,122.17 1,290.50 # 40806 32.62 30.99 35.64 38724 1,276.82 1,212.98 1,394.93 40808 167.83 159.44 183.36 38740 606.00 575.70 662.06 # 40808 101.27 96.21 110.64 38745 770.36 731.84 841.62 40810 187.36 177.99 204.69 38746 250.11 237.60 273.24 # 40810 119.96 113.96 131.05 38747 246.03 233.73 268.79 40812 260.99 247.94 285.13 38760 760.78 722.74 831.15 # 40812 185.59 176.31 202.76 38765 1,171.38 1,112.81 1,279.73 40814 352.99 335.34 385.64 38770 776.53 737.70 848.36 # 40814 288.54 274.11 315.23 38780 990.38 940.86 1,081.99 40816 370.39 351.87 404.65 38790 79.21 75.25 86.54 # 40816 300.89 285.85 328.73 38792 38.82 36.88 42.41 40818 330.03 313.53 360.56 38794 301.29 286.23 329.16 # 40818 260.94 247.89 285.07 39000 467.69 444.31 510.96 40819 281.52 267.44 307.56 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 34 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 40819 222.12 211.01 242.66 41145 2,597.03 2,467.18 2,837.26 40820 241.63 229.55 263.98 41150 2,061.99 1,958.89 2,252.72 # 40820 160.33 152.31 175.16 41153 2,216.02 2,105.22 2,421.00 40830 229.35 217.88 250.56 41155 2,701.43 2,566.36 2,951.31 # 40830 152.26 144.65 166.35 41250 209.61 199.13 229.00 40831 301.89 286.80 329.82 # 41250 129.15 122.69 141.09 # 40831 214.69 203.96 234.55 41251 226.45 215.13 247.40 40840 754.73 716.99 824.54 # 41251 153.99 146.29 168.23 # 40840 601.82 571.73 657.49 41252 288.17 273.76 314.82 40842 764.42 726.20 835.13 # 41252 201.81 191.72 220.48 # 40842 600.56 570.53 656.11 41500 450.69 428.16 492.38 40843 958.52 910.59 1,047.18 41510 426.31 404.99 465.74 # 40843 753.38 715.71 823.07 41520 321.56 305.48 351.30 40844 1,272.45 1,208.83 1,390.15 # 41520 246.58 234.25 269.39 # 40844 1,055.09 1,002.34 1,152.69 41800 200.49 190.47 219.04 40845 1,403.66 1,333.48 1,533.50 # 41800 116.25 110.44 127.01 # 40845 1,200.20 1,140.19 1,311.22 41805 201.41 191.34 220.04 41000 150.87 143.33 164.83 # 41805 150.86 143.32 164.82 # 41000 105.80 100.51 115.59 41806 301.54 286.46 329.43 41005 208.27 197.86 227.54 # 41806 237.52 225.64 259.49 # 41005 120.65 114.62 131.81 41822 271.92 258.32 297.07 41006 336.59 319.76 367.72 # 41822 167.04 158.69 182.49 # 41006 247.71 235.32 270.62 41823 389.99 370.49 426.06 41007 336.26 319.45 367.37 # 41823 299.84 284.85 327.58 # 41007 236.43 224.61 258.30 41825 192.52 182.89 210.32 41008 342.10 325.00 373.75 # 41825 128.49 122.07 140.38 # 41008 254.48 241.76 278.02 41826 246.77 234.43 269.59 41009 364.29 346.08 397.99 # 41826 186.95 177.60 204.24 # 41009 278.36 264.44 304.11 41827 392.41 372.79 428.71 41010 192.71 183.07 210.53 # 41827 284.57 270.34 310.89 # 41010 105.09 99.84 114.82 41828 284.67 270.44 311.01 41015 395.22 375.46 431.78 # 41828 215.16 204.40 235.06 # 41015 319.82 303.83 349.40 41830 357.90 340.01 391.01 41016 404.10 383.90 441.49 # 41830 269.44 255.97 294.37 # 41016 329.54 313.06 360.02 41872 339.74 322.75 371.16 41017 407.89 387.50 445.63 # 41872 249.17 236.71 272.22 # 41017 332.07 315.47 362.79 41874 340.50 323.48 372.00 41018 465.83 442.54 508.92 # 41874 243.61 231.43 266.14 # 41018 384.95 365.70 420.56 42000 151.94 144.34 165.99 41019 454.24 431.53 496.26 # 42000 97.60 92.72 106.63 41100 158.70 150.77 173.39 42100 140.60 133.57 153.61 # 41100 105.63 100.35 115.40 # 42100 103.95 98.75 113.56 41105 157.50 149.63 172.07 42104 189.69 180.21 207.24 # 41105 105.68 100.40 115.46 # 42104 128.61 122.18 140.51 41108 135.94 129.14 148.51 42106 240.97 228.92 263.26 # 41108 85.81 81.52 93.75 # 42106 174.42 165.70 190.56 41110 195.53 185.75 213.61 42107 422.91 401.76 462.02 # 41110 124.76 118.52 136.30 # 42107 325.60 309.32 355.72 41112 307.12 291.76 335.52 42120 917.38 871.51 1,002.24 # 41112 238.04 226.14 260.06 42140 234.32 222.60 255.99 41113 335.21 318.45 366.22 # 42140 148.39 140.97 162.12 # 41113 263.60 250.42 287.98 42145 660.23 627.22 721.30 41114 603.39 573.22 659.20 42160 235.38 223.61 257.15 41115 222.39 211.27 242.96 # 42160 150.29 142.78 164.20 # 41115 140.25 133.24 153.23 42180 227.08 215.73 248.09 41116 299.44 284.47 327.14 # 42180 174.85 166.11 191.03 # 41116 208.45 198.03 227.73 42182 307.17 291.81 335.58 41120 1,016.96 966.11 1,111.03 # 42182 255.78 242.99 279.44 41130 1,227.88 1,166.49 1,341.46 42200 854.08 811.38 933.09 41135 2,014.10 1,913.40 2,200.41 42205 873.01 829.36 953.76 41140 2,100.08 1,995.08 2,294.34 42210 1,026.10 974.80 1,121.02 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 35 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 42215 686.72 652.38 750.24 42720 426.95 405.60 466.44 42220 555.69 527.91 607.10 # 42720 373.03 354.38 407.54 42225 969.71 921.22 1,059.40 42725 764.13 725.92 834.81 42226 936.90 890.06 1,023.57 42800 149.01 141.56 162.79 42227 924.79 878.55 1,010.33 # 42800 107.72 102.33 117.68 42235 756.91 719.06 826.92 42802 243.59 231.41 266.12 42260 798.71 758.77 872.59 # 42802 134.91 128.16 147.38 # 42260 654.65 621.92 715.21 42804 199.74 189.75 218.21 42280 146.70 139.37 160.28 # 42804 113.81 108.12 124.34 # 42280 99.94 94.94 109.18 42806 224.37 213.15 245.12 42281 190.28 180.77 207.89 # 42806 132.54 125.91 144.80 # 42281 146.04 138.74 159.55 42808 217.05 206.20 237.13 42300 196.29 186.48 214.45 # 42808 158.50 150.58 173.17 # 42300 145.75 138.46 159.23 42809 162.59 154.46 177.63 42305 409.51 389.03 447.38 # 42809 122.15 116.04 133.45 42310 153.25 145.59 167.43 42810 371.78 353.19 406.17 # 42310 118.71 112.77 129.69 # 42810 273.63 259.95 298.94 42320 234.31 222.59 255.98 42815 529.66 503.18 578.66 # 42320 170.28 161.77 186.04 42820 279.37 265.40 305.21 42330 219.04 208.09 239.30 42821 293.14 278.48 320.25 # 42330 156.27 148.46 170.73 42825 252.15 239.54 275.47 42335 346.78 329.44 378.86 42826 243.25 231.09 265.75 # 42335 248.21 235.80 271.17 42830 199.14 189.18 217.56 42340 438.21 416.30 478.75 42831 215.25 204.49 235.16 # 42340 325.74 309.45 355.87 42835 174.22 165.51 190.34 42400 104.93 99.68 114.63 42836 234.70 222.97 256.42 # 42400 56.91 54.06 62.17 42842 912.33 866.71 996.72 42405 287.66 273.28 314.27 42844 1,296.19 1,231.38 1,416.09 # 42405 216.89 206.05 236.96 42845 2,086.66 1,982.33 2,279.68 42408 427.96 406.56 467.54 42860 180.33 171.31 197.01 # 42408 312.96 297.31 341.91 42870 560.86 532.82 612.74 42409 311.61 296.03 340.43 42890 1,290.09 1,225.59 1,409.43 # 42409 215.99 205.19 235.97 42892 1,675.27 1,591.51 1,830.24 42410 591.08 561.53 645.76 42894 2,151.33 2,043.76 2,350.32 42415 1,061.10 1,008.05 1,159.26 42900 332.00 315.40 362.71 42420 1,216.92 1,156.07 1,329.48 42950 780.51 741.48 852.70 42425 806.18 765.87 880.75 42953 997.10 947.25 1,089.34 42426 1,300.84 1,235.80 1,421.17 42955 728.97 692.52 796.40 42440 438.26 416.35 478.80 42960 162.60 154.47 177.64 42450 428.48 407.06 468.12 42961 404.47 384.25 441.89 # 42450 344.23 327.02 376.07 42962 498.17 473.26 544.25 42500 407.33 386.96 445.00 42970 369.58 351.10 403.77 # 42500 328.14 311.73 358.49 42971 438.82 416.88 479.41 42505 530.34 503.82 579.39 42972 498.23 473.32 544.32 # 42505 439.35 417.38 479.99 43020 511.69 486.11 559.03 42507 493.84 469.15 539.52 43030 499.35 474.38 545.54 42508 688.44 654.02 752.12 43045 1,232.23 1,170.62 1,346.21 42509 824.09 782.89 900.32 43100 591.38 561.81 646.08 42510 608.23 577.82 664.49 43101 960.51 912.48 1,049.35 42550 160.13 152.12 174.94 43107 2,369.60 2,251.12 2,588.79 # 42550 62.40 59.28 68.17 43108 3,729.16 3,542.70 4,074.11 42600 454.22 431.51 496.24 43112 2,537.47 2,410.60 2,772.19 # 42600 335.85 319.06 366.92 43113 3,682.41 3,498.29 4,023.03 42650 78.31 74.39 85.55 43116 4,215.97 4,005.17 4,605.95 # 42650 56.82 53.98 62.08 43117 2,308.53 2,193.10 2,522.07 42660 100.03 95.03 109.28 43118 3,125.37 2,969.10 3,414.47 # 42660 74.75 71.01 81.66 43121 2,520.09 2,394.09 2,753.20 42665 286.92 272.57 313.46 43122 2,342.98 2,225.83 2,559.70 # 42665 198.88 188.94 217.28 43123 3,765.27 3,577.01 4,113.56 42700 177.49 168.62 193.91 43124 3,225.70 3,064.42 3,524.08 # 42700 129.47 123.00 141.45 43130 747.58 710.20 816.73 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 36 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 43135 1,330.66 1,264.13 1,453.75 43305 1,054.32 1,001.60 1,151.84 43200 223.14 211.98 243.78 43310 1,432.04 1,360.44 1,564.51 # 43200 100.56 95.53 109.86 43312 1,574.58 1,495.85 1,720.23 43201 291.16 276.60 318.09 43313 2,555.48 2,427.71 2,791.87 # 43201 123.51 117.33 134.93 43314 2,716.71 2,580.87 2,968.00 43202 293.95 279.25 321.14 43320 1,240.25 1,178.24 1,354.98 # 43202 108.60 103.17 118.65 43324 1,215.37 1,154.60 1,327.79 43204 210.08 199.58 229.52 43325 1,198.80 1,138.86 1,309.69 43205 211.51 200.93 231.07 43326 1,223.36 1,162.19 1,336.52 43215 146.66 139.33 160.23 43330 1,174.52 1,115.79 1,283.16 43216 174.12 165.41 190.22 43331 1,275.72 1,211.93 1,393.72 # 43216 135.79 129.00 148.35 43340 1,230.39 1,168.87 1,344.20 43217 390.78 371.24 426.93 43341 1,315.89 1,250.10 1,437.62 # 43217 159.51 151.53 174.26 43350 1,056.84 1,004.00 1,154.60 43219 163.01 154.86 178.09 43351 1,247.87 1,185.48 1,363.30 43220 120.28 114.27 131.41 43352 1,003.07 952.92 1,095.86 43226 133.57 126.89 145.92 43360 2,128.16 2,021.75 2,325.01 43227 197.41 187.54 215.67 43361 2,409.73 2,289.24 2,632.63 43228 209.60 199.12 228.99 43400 1,404.29 1,334.08 1,534.19 43231 179.12 170.16 195.68 43401 1,382.63 1,313.50 1,510.53 43232 249.77 237.28 272.87 43405 1,341.05 1,274.00 1,465.10 43234 290.34 275.82 317.19 43410 923.80 877.61 1,009.25 # 43234 112.58 106.95 122.99 43415 1,571.65 1,493.07 1,717.03 43235 306.55 291.22 334.90 43420 918.53 872.60 1,003.49 # 43235 135.94 129.14 148.51 43425 1,362.81 1,294.67 1,488.87 43236 381.20 362.14 416.46 43450 162.14 154.03 177.13 # 43236 165.10 156.85 180.38 # 43450 84.21 80.00 92.00 43237 226.32 215.00 247.25 43453 315.06 299.31 344.21 43238 278.03 264.13 303.75 # 43453 90.96 86.41 99.37 43239 351.74 334.15 384.27 43456 656.72 623.88 717.46 # 43239 161.34 153.27 176.26 # 43456 146.17 138.86 159.69 43240 372.32 353.70 406.76 43458 396.39 376.57 433.06 43241 146.40 139.08 159.94 # 43458 171.02 162.47 186.84 43242 397.72 377.83 434.50 43460 205.63 195.35 224.65 43243 251.69 239.11 274.98 43496 2,088.46 1,984.04 2,281.65 43244 278.69 264.76 304.47 43500 688.74 654.30 752.45 43245 176.68 167.85 193.03 43501 1,183.87 1,124.68 1,293.38 43246 235.97 224.17 257.80 43502 1,344.65 1,277.42 1,469.03 43247 188.94 179.49 206.41 43510 882.49 838.37 964.13 43248 178.00 169.10 194.47 43520 631.62 600.04 690.05 43249 163.79 155.60 178.94 43600 98.54 93.61 107.65 43250 177.45 168.58 193.87 43605 732.09 695.49 799.81 43251 204.95 194.70 223.91 43610 863.91 820.71 943.82 43255 266.20 252.89 290.82 43611 1,071.78 1,018.19 1,170.92 43256 239.51 227.53 261.66 43620 1,746.26 1,658.95 1,907.79 43257 287.83 273.44 314.46 43621 1,965.46 1,867.19 2,147.27 43258 250.92 238.37 274.13 43622 2,005.30 1,905.04 2,190.80 43259 284.34 270.12 310.64 43631 1,287.14 1,222.78 1,406.20 43260 326.33 310.01 356.51 43632 1,702.57 1,617.44 1,860.06 43261 343.06 325.91 374.80 43633 1,629.59 1,548.11 1,780.33 43262 402.81 382.67 440.07 43634 1,793.72 1,704.03 1,959.63 43263 396.83 376.99 433.54 43635 103.21 98.05 112.76 43264 483.23 459.07 527.93 43640 1,031.48 979.91 1,126.90 43265 542.60 515.47 592.79 43641 1,048.04 995.64 1,144.99 43267 395.65 375.87 432.25 43644 1,531.37 1,454.80 1,673.02 43268 408.29 387.88 446.06 43645 1,639.33 1,557.36 1,790.96 43269 446.12 423.81 487.38 43651 579.54 550.56 633.14 43271 402.39 382.27 439.61 43652 687.34 652.97 750.92 43272 403.65 383.47 440.99 43653 495.30 470.54 541.12 43280 969.43 920.96 1,059.10 43752 38.78 36.84 42.37 43300 593.15 563.49 648.01 43760 203.18 193.02 221.97 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 37 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 43760 49.43 46.96 54.00 44157 2,036.67 1,934.84 2,225.07 43761 118.12 112.21 129.04 44158 2,088.64 1,984.21 2,281.84 # 43761 100.43 95.41 109.72 44160 1,094.32 1,039.60 1,195.54 43770 987.02 937.67 1,078.32 44180 822.51 781.38 898.59 43771 1,125.86 1,069.57 1,230.01 44186 583.50 554.33 637.48 43772 846.80 804.46 925.13 44187 987.53 938.15 1,078.87 43773 1,125.74 1,069.45 1,229.87 44188 1,084.71 1,030.47 1,185.04 43774 852.68 810.05 931.56 44202 1,234.02 1,172.32 1,348.17 43800 819.94 778.94 895.78 44203 222.23 211.12 242.79 43810 884.89 840.65 966.75 44204 1,377.92 1,309.02 1,505.37 43820 1,122.84 1,066.70 1,226.71 44205 1,205.38 1,145.11 1,316.88 43825 1,142.08 1,084.98 1,247.73 44206 1,562.25 1,484.14 1,706.76 43830 611.72 581.13 668.30 44207 1,638.47 1,556.55 1,790.03 43831 512.75 487.11 560.18 44208 1,789.93 1,700.43 1,955.49 43832 935.51 888.73 1,022.04 44210 1,597.29 1,517.43 1,745.04 43840 1,142.68 1,085.55 1,248.38 44211 1,965.97 1,867.67 2,147.82 43843 1,114.15 1,058.44 1,217.21 44212 1,837.47 1,745.60 2,007.44 43845 1,738.80 1,651.86 1,899.64 44213 175.13 166.37 191.33 43846 1,437.00 1,365.15 1,569.92 44227 1,487.38 1,413.01 1,624.96 43847 1,574.61 1,495.88 1,720.26 44300 741.50 704.43 810.09 43848 1,703.24 1,618.08 1,860.79 44310 926.21 879.90 1,011.89 43850 1,432.24 1,360.63 1,564.72 44312 524.82 498.58 573.37 43855 1,490.69 1,416.16 1,628.58 44314 894.54 849.81 977.28 43860 1,446.83 1,374.49 1,580.66 44316 1,230.63 1,169.10 1,344.47 43865 1,508.37 1,432.95 1,647.89 44320 1,056.12 1,003.31 1,153.81 43870 620.85 589.81 678.28 44322 862.67 819.54 942.47 43880 1,415.57 1,344.79 1,546.51 44340 531.43 504.86 580.59 43886 299.50 284.53 327.21 44345 925.78 879.49 1,011.41 43887 280.93 266.88 306.91 44346 1,035.86 984.07 1,131.68 43888 398.86 378.92 435.76 44360 147.90 140.51 161.59 44005 965.52 917.24 1,054.83 44361 162.72 154.58 177.77 44010 759.46 721.49 829.71 44363 193.66 183.98 211.58 44015 131.94 125.34 144.14 44364 206.77 196.43 225.89 44020 852.24 809.63 931.07 44365 184.10 174.90 201.14 44021 859.40 816.43 938.89 44366 244.37 232.15 266.97 44025 866.36 823.04 946.50 44369 248.51 236.08 271.49 44050 825.47 784.20 901.83 44370 268.56 255.13 293.40 44055 1,312.10 1,246.50 1,433.48 44372 240.22 228.21 262.44 44100 107.10 101.75 117.01 44373 192.82 183.18 210.66 44110 744.03 706.83 812.85 44376 284.56 270.33 310.88 44111 868.37 824.95 948.69 44377 301.59 286.51 329.49 44120 1,067.28 1,013.92 1,166.01 44378 388.33 368.91 424.25 44121 222.95 211.80 243.57 44379 414.63 393.90 452.99 44125 1,041.91 989.81 1,138.28 44380 65.06 61.81 71.08 44126 2,143.51 2,036.33 2,341.78 44382 77.30 73.44 84.46 44127 2,491.91 2,367.31 2,722.41 44383 166.29 157.98 181.68 44128 225.96 214.66 246.86 44385 239.83 227.84 262.02 44130 1,097.96 1,043.06 1,199.52 # 44385 100.40 95.38 109.69 44137 1,021.31 970.24 1,115.78 44386 357.84 339.95 390.94 44139 111.37 105.80 121.67 # 44386 117.73 111.84 128.62 44140 1,192.02 1,132.42 1,302.28 44388 338.81 321.87 370.15 44141 1,541.96 1,464.86 1,684.59 # 44388 155.57 147.79 169.96 44143 1,466.45 1,393.13 1,602.10 44389 403.34 383.17 440.65 44144 1,516.89 1,441.05 1,657.21 # 44389 173.77 165.08 189.84 44145 1,486.93 1,412.58 1,624.47 44390 464.08 440.88 507.01 44146 1,841.54 1,749.46 2,011.88 # 44390 210.07 199.57 229.51 44147 1,620.37 1,539.35 1,770.25 44391 528.31 501.89 577.17 44150 1,623.01 1,541.86 1,773.14 # 44391 238.08 226.18 260.11 44151 1,853.30 1,760.64 2,024.74 44392 433.09 411.44 473.16 44155 1,817.92 1,727.02 1,986.07 # 44392 206.46 196.14 225.56 44156 1,997.38 1,897.51 2,182.14 44393 490.26 465.75 535.61 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 38 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 44393 259.84 246.85 283.88 45305 168.07 159.67 183.62 44394 504.32 479.10 550.97 # 45305 68.65 65.22 75.00 # 44394 240.20 228.19 262.42 45307 193.10 183.45 210.97 44397 253.88 241.19 277.37 # 45307 85.68 81.40 93.61 44500 24.55 23.32 26.82 45308 163.61 155.43 178.74 44602 1,191.11 1,131.55 1,301.28 # 45308 72.20 68.59 78.88 44603 1,361.15 1,293.09 1,487.05 45309 190.75 181.21 208.39 44604 937.07 890.22 1,023.75 # 45309 88.81 84.37 97.03 44605 1,160.07 1,102.07 1,267.38 45315 206.17 195.86 225.24 44615 951.08 903.53 1,039.06 # 45315 97.07 92.22 106.05 44620 758.36 720.44 828.51 45317 194.16 184.45 212.12 44625 899.24 854.28 982.42 # 45317 101.91 96.81 111.33 44626 1,431.54 1,359.96 1,563.95 45320 198.12 188.21 216.44 44640 1,247.59 1,185.21 1,362.99 # 45320 96.60 91.77 105.54 44650 1,295.79 1,231.00 1,415.65 45321 92.87 88.23 101.46 44660 1,250.03 1,187.53 1,365.66 45327 106.00 100.70 115.81 44661 1,404.44 1,334.22 1,534.35 45330 136.10 129.30 148.70 44680 940.77 893.73 1,027.79 # 45330 58.59 55.66 64.01 44700 912.75 867.11 997.18 45331 175.39 166.62 191.61 44701 154.13 146.42 168.38 # 45331 70.50 66.98 77.03 44715 351.75 334.16 384.28 45332 287.39 273.02 313.97 44720 242.61 230.48 265.05 # 45332 103.31 98.14 112.86 44721 353.37 335.70 386.06 45333 287.09 272.74 313.65 44800 676.31 642.49 738.86 # 45333 102.59 97.46 112.08 44820 740.85 703.81 809.38 45334 154.49 146.77 168.79 44850 658.87 625.93 719.82 45335 233.07 221.42 254.63 44900 664.56 631.33 726.03 # 45335 86.05 81.75 94.01 44901 1,125.59 1,069.31 1,229.71 45337 133.25 126.59 145.58 # 44901 168.95 160.50 184.58 45338 319.34 303.37 348.88 44950 570.50 541.98 623.28 # 45338 132.73 126.09 145.00 44955 77.57 73.69 84.74 45339 307.80 292.41 336.27 44960 761.01 722.96 831.40 # 45339 175.96 167.16 192.23 44970 524.22 498.01 572.71 45340 414.42 393.70 452.76 45000 362.74 344.60 396.29 # 45340 107.34 101.97 117.27 45005 244.34 232.12 266.94 45341 147.02 139.67 160.62 # 45005 141.55 134.47 154.64 45342 223.84 212.65 244.55 45020 465.78 442.49 508.86 45345 161.49 153.42 176.43 45100 256.14 243.33 279.83 45355 191.65 182.07 209.38 45108 311.82 296.23 340.66 45378 397.76 377.87 434.55 45110 1,644.16 1,561.95 1,796.24 # 45378 203.15 192.99 221.94 45111 964.36 916.14 1,053.56 45378 53 136.10 129.30 148.70 45112 1,683.95 1,599.75 1,839.71 # 45378 53 58.59 55.66 64.01 45113 1,731.52 1,644.94 1,891.68 45379 501.22 476.16 547.58 45114 1,581.21 1,502.15 1,727.47 # 45379 253.53 240.85 276.98 45116 1,431.67 1,360.09 1,564.10 45380 475.16 451.40 519.11 45119 1,732.65 1,646.02 1,892.92 # 45380 243.90 231.71 266.47 45120 1,382.27 1,313.16 1,510.13 45381 463.08 439.93 505.92 45121 1,519.92 1,443.92 1,660.51 # 45381 230.55 219.02 251.87 45123 978.09 929.19 1,068.57 45382 631.62 600.04 690.05 45126 2,562.32 2,434.20 2,799.33 # 45382 311.05 295.50 339.83 45130 957.59 909.71 1,046.17 45383 559.40 531.43 611.14 45135 1,177.50 1,118.63 1,286.42 # 45383 314.65 298.92 343.76 45136 1,634.53 1,552.80 1,785.72 45384 464.66 441.43 507.64 45150 345.81 328.52 377.80 # 45384 254.46 241.74 278.00 45160 872.00 828.40 952.66 45385 532.49 505.87 581.75 45170 685.23 650.97 748.62 # 45385 289.01 274.56 315.74 45190 594.92 565.17 649.95 45386 687.79 653.40 751.41 45300 101.34 96.27 110.71 # 45386 249.28 236.82 272.34 # 45300 43.63 41.45 47.67 45387 322.09 305.99 351.89 45303 865.54 822.26 945.60 45391 280.88 266.84 306.87 # 45303 72.77 69.13 79.50 45392 353.56 335.88 386.26 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 39 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 45395 1,777.17 1,688.31 1,941.56 # 46270 318.37 302.45 347.82 45397 1,918.37 1,822.45 2,095.82 46275 432.24 410.63 472.22 45400 1,027.11 975.75 1,122.11 # 46275 341.25 324.19 372.82 45402 1,370.19 1,301.68 1,496.93 46280 390.27 370.76 426.37 45500 449.10 426.65 490.65 46285 409.62 389.14 447.51 45505 490.14 465.63 535.47 # 46285 333.80 317.11 364.68 45520 114.69 108.96 125.30 46288 458.61 435.68 501.03 # 45520 35.92 34.12 39.24 46320 155.86 148.07 170.28 45540 930.35 883.83 1,016.40 # 46320 96.47 91.65 105.40 45541 807.64 767.26 882.35 46500 180.50 171.48 197.20 45550 1,294.48 1,229.76 1,414.22 # 46500 110.57 105.04 120.80 45560 642.55 610.42 701.98 46505 243.16 231.00 265.65 45562 974.96 926.21 1,065.14 # 46505 199.36 189.39 217.80 45563 1,427.01 1,355.66 1,559.01 46600 81.83 77.74 89.40 45800 1,086.51 1,032.18 1,187.01 # 46600 35.07 33.32 38.32 45805 1,253.48 1,190.81 1,369.43 46604 494.70 469.97 540.47 45820 1,082.98 1,028.83 1,183.15 # 46604 62.09 58.99 67.84 45825 1,286.41 1,222.09 1,405.40 46606 204.69 194.46 223.63 45900 175.65 166.87 191.90 # 46606 64.41 61.19 70.37 45905 149.94 142.44 163.81 46608 220.39 209.37 240.78 45910 177.83 168.94 194.28 # 46608 74.21 70.50 81.08 45915 295.06 280.31 322.36 46610 212.54 201.91 232.20 # 45915 202.39 192.27 221.11 # 46610 73.11 69.45 79.87 45990 98.09 93.19 107.17 46611 172.84 164.20 188.83 46020 226.58 215.25 247.54 # 46611 77.64 73.76 84.82 # 46020 197.09 187.24 215.33 46612 267.11 253.75 291.81 46030 114.24 108.53 124.81 # 46612 94.83 90.09 103.60 # 46030 78.02 74.12 85.24 46614 129.47 123.00 141.45 46040 449.75 427.26 491.35 # 46614 68.39 64.97 74.72 # 46040 355.39 337.62 388.26 46615 149.40 141.93 163.22 46045 355.85 338.06 388.77 # 46615 96.32 91.50 105.23 46050 166.13 157.82 181.49 46700 552.09 524.49 603.16 # 46050 83.57 79.39 91.30 46705 437.68 415.80 478.17 46060 391.98 372.38 428.24 46706 147.41 140.04 161.05 46070 191.26 181.70 208.96 46710 938.15 891.24 1,024.93 46080 207.95 197.55 227.18 46712 1,948.62 1,851.19 2,128.87 # 46080 140.97 133.92 154.01 46715 436.42 414.60 476.79 46083 155.22 147.46 169.58 46716 996.39 946.57 1,088.56 # 46083 92.03 87.43 100.54 46730 1,609.54 1,529.06 1,758.42 46200 342.62 325.49 374.31 46735 1,902.06 1,806.96 2,078.00 # 46200 268.06 254.66 292.86 46740 1,801.98 1,711.88 1,968.66 46210 331.76 315.17 362.45 46742 2,091.52 1,986.94 2,284.98 # 46210 226.03 214.73 246.94 46744 2,993.60 2,843.92 3,270.51 46211 439.42 417.45 480.07 46746 3,368.29 3,199.88 3,679.86 # 46211 332.42 315.80 363.17 46748 3,437.29 3,265.43 3,755.24 46220 170.46 161.94 186.23 46750 666.65 633.32 728.32 # 46220 101.37 96.30 110.75 46751 558.35 530.43 609.99 46221 219.13 208.17 239.40 46753 503.56 478.38 550.14 # 46221 163.52 155.34 178.64 46754 255.18 242.42 278.78 46230 235.03 223.28 256.77 # 46754 184.83 175.59 201.93 # 46230 151.62 144.04 165.65 46760 947.98 900.58 1,035.67 46250 392.30 372.69 428.59 46761 817.74 776.85 893.38 # 46250 269.72 256.23 294.66 46762 797.70 757.82 871.49 46255 438.84 416.90 479.44 46900 200.96 190.91 219.55 # 46255 306.57 291.24 334.93 # 46900 123.87 117.68 135.33 46257 352.49 334.87 385.10 46910 212.16 201.55 231.78 46258 384.55 365.32 420.12 # 46910 116.96 111.11 127.78 46260 400.44 380.42 437.48 46916 212.71 202.07 232.38 46261 447.81 425.42 489.23 # 46916 129.31 122.84 141.27 46262 465.29 442.03 508.33 46917 447.39 425.02 488.77 46270 416.09 395.29 454.58 # 46917 119.25 113.29 130.28 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 40 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 46922 226.54 215.21 247.49 47505 37.85 35.96 41.35 # 46922 117.86 111.97 128.77 47510 484.92 460.67 529.77 46924 486.78 462.44 531.81 47511 594.56 564.83 649.55 # 46924 162.00 153.90 176.99 47525 828.46 787.04 905.10 46934 361.79 343.70 395.26 # 47525 313.28 297.62 342.26 # 46934 260.27 247.26 284.35 47530 1,568.85 1,490.41 1,713.97 46935 243.53 231.35 266.05 # 47530 363.25 345.09 396.85 # 46935 138.22 131.31 151.01 47550 151.92 144.32 165.97 46936 369.43 350.96 403.60 47552 318.61 302.68 348.08 # 46936 243.48 231.31 266.01 47553 316.09 300.29 345.33 46937 225.64 214.36 246.51 47554 474.31 450.59 518.18 # 46937 151.08 143.53 165.06 47555 378.48 359.56 413.49 46938 378.79 359.85 413.83 47556 427.64 406.26 467.20 # 46938 315.18 299.42 344.33 47560 245.48 233.21 268.19 46940 187.46 178.09 204.80 47561 268.01 254.61 292.80 # 46940 130.59 124.06 142.67 47562 652.60 619.97 712.97 46942 172.84 164.20 188.83 47563 671.73 638.14 733.86 # 46942 116.82 110.98 127.63 47564 775.72 736.93 847.47 46945 247.56 235.18 270.46 47570 691.43 656.86 755.39 # 46945 192.80 183.16 210.63 47600 921.39 875.32 1,006.62 46946 272.00 258.40 297.16 47605 866.68 823.35 946.85 # 46946 202.08 191.98 220.78 47610 1,106.57 1,051.24 1,208.93 46947 330.31 313.79 360.86 47612 1,115.82 1,060.03 1,219.03 47000 293.85 279.16 321.03 47620 1,209.72 1,149.23 1,321.61 # 47000 95.45 90.68 104.28 47630 545.42 518.15 595.87 47001 95.55 90.77 104.39 47700 925.52 879.24 1,011.13 47010 1,057.27 1,004.41 1,155.07 47701 1,542.71 1,465.57 1,685.41 47011 184.32 175.10 201.37 47711 1,373.64 1,304.96 1,500.70 47015 1,005.55 955.27 1,098.56 47712 1,759.48 1,671.51 1,922.24 47100 737.67 700.79 805.91 47715 1,156.88 1,099.04 1,263.90 47120 2,066.04 1,962.74 2,257.15 47720 998.16 948.25 1,090.49 47122 3,067.59 2,914.21 3,351.34 47721 1,174.30 1,115.59 1,282.93 47125 2,753.81 2,616.12 3,008.54 47740 1,136.89 1,080.05 1,242.06 47130 2,959.42 2,811.45 3,233.17 47741 1,288.42 1,224.00 1,407.60 47135 4,360.34 4,142.32 4,763.67 47760 1,893.77 1,799.08 2,068.94 47136 3,717.33 3,531.46 4,061.18 47765 2,439.77 2,317.78 2,665.45 47140 3,080.33 2,926.31 3,365.26 47780 2,061.51 1,958.43 2,252.19 47141 3,663.77 3,480.58 4,002.67 47785 2,662.37 2,529.25 2,908.64 47142 4,028.32 3,826.90 4,400.94 47800 1,389.22 1,319.76 1,517.72 47143 297.79 282.90 325.34 47801 973.86 925.17 1,063.95 47144 446.68 424.35 488.00 47802 1,331.13 1,264.57 1,454.26 47145 446.68 424.35 488.00 47900 1,206.30 1,145.99 1,317.89 47146 302.79 287.65 330.80 48000 1,649.93 1,567.43 1,802.54 47147 352.95 335.30 385.60 48001 2,037.91 1,936.01 2,226.41 47300 983.45 934.28 1,074.42 48020 1,018.18 967.27 1,112.36 47350 1,204.35 1,144.13 1,315.75 48100 777.17 738.31 849.06 47360 1,635.14 1,553.38 1,786.39 48102 536.26 509.45 585.87 47361 2,704.82 2,569.58 2,955.02 # 48102 247.71 235.32 270.62 47362 1,245.24 1,182.98 1,360.43 48105 2,504.30 2,379.09 2,735.95 47370 1,107.97 1,052.57 1,210.46 48120 970.52 921.99 1,060.29 47371 1,114.11 1,058.40 1,217.16 48140 1,373.75 1,305.06 1,500.82 47380 1,289.29 1,224.83 1,408.55 48145 1,424.37 1,353.15 1,556.12 47381 1,318.88 1,252.94 1,440.88 48146 1,636.21 1,554.40 1,787.56 47382 800.59 760.56 874.64 48148 1,085.95 1,031.65 1,186.40 47400 1,873.10 1,779.45 2,046.37 48150 2,757.80 2,619.91 3,012.90 47420 1,183.85 1,124.66 1,293.36 48152 2,548.80 2,421.36 2,784.56 47425 1,196.09 1,136.29 1,306.73 48153 2,755.05 2,617.30 3,009.90 47460 1,124.04 1,067.84 1,228.02 48154 2,563.11 2,434.95 2,800.19 47480 750.09 712.59 819.48 48155 1,584.26 1,505.05 1,730.81 47490 513.55 487.87 561.05 48400 97.85 92.96 106.90 47500 98.17 93.26 107.25 48500 985.84 936.55 1,077.03 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 41 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 48510 947.70 900.32 1,035.37 49435 110.45 104.93 120.67 48511 1,007.47 957.10 1,100.67 49436 169.22 160.76 184.87 # 48511 199.53 189.55 217.98 49440 1,211.46 1,150.89 1,323.52 48520 956.71 908.87 1,045.20 # 49440 232.07 220.47 253.54 48540 1,151.43 1,093.86 1,257.94 49441 1,438.98 1,367.03 1,572.08 48545 1,163.12 1,104.96 1,270.70 # 49441 254.45 241.73 277.99 48547 1,561.50 1,483.43 1,705.94 49442 1,172.56 1,113.93 1,281.02 48548 1,464.67 1,391.44 1,600.16 # 49442 210.86 200.32 230.37 48551 202.40 192.28 221.12 49446 1,202.97 1,142.82 1,314.24 48552 209.41 198.94 228.78 # 49446 165.45 157.18 180.76 48554 2,193.51 2,083.83 2,396.40 49450 847.52 805.14 925.91 48556 1,076.43 1,022.61 1,176.00 # 49450 66.96 63.61 73.15 49000 688.37 653.95 752.04 49451 895.70 850.92 978.56 49002 873.74 830.05 954.56 # 49451 92.39 87.77 100.94 49010 839.75 797.76 917.42 49452 1,092.39 1,037.77 1,193.44 49020 1,401.99 1,331.89 1,531.67 # 49452 144.17 136.96 157.50 49021 977.55 928.67 1,067.97 49460 901.44 856.37 984.83 # 49021 168.77 160.33 184.38 # 49460 47.16 44.80 51.52 49040 877.71 833.82 958.89 49465 185.86 176.57 203.06 49041 972.93 924.28 1,062.92 # 49465 31.26 29.70 34.16 # 49041 199.53 189.55 217.98 49491 665.01 631.76 726.52 49060 983.74 934.55 1,074.73 49492 831.55 789.97 908.47 49061 961.09 913.04 1,050.00 49495 356.85 339.01 389.86 # 49061 184.74 175.50 201.83 49496 530.62 504.09 579.70 49062 672.89 639.25 735.14 49500 358.11 340.20 391.23 49080 189.58 180.10 207.12 49501 525.11 498.85 573.68 # 49080 67.84 64.45 74.12 49505 457.54 434.66 499.86 49081 161.53 153.45 176.47 49507 562.27 534.16 614.28 # 49081 64.23 61.02 70.17 49520 558.54 530.61 610.20 49180 178.82 169.88 195.36 49521 680.20 646.19 743.12 # 49180 86.15 81.84 94.12 49525 505.36 480.09 552.10 49203 1,066.12 1,012.81 1,164.73 49540 597.50 567.63 652.77 49204 1,356.91 1,289.06 1,482.42 49550 508.80 483.36 555.86 49205 1,551.20 1,473.64 1,694.69 49553 555.46 527.69 606.84 49215 1,966.29 1,867.98 2,148.18 49555 528.65 502.22 577.55 49220 862.57 819.44 942.36 49557 640.57 608.54 699.82 49250 514.97 489.22 562.60 49560 656.63 623.80 717.37 49255 698.81 663.87 763.45 49561 823.07 781.92 899.21 49320 298.30 283.39 325.90 49565 677.49 643.62 740.16 49321 312.68 297.05 341.61 49566 831.57 789.99 908.49 49322 341.01 323.96 372.55 49568 245.18 232.92 267.86 49323 571.43 542.86 624.29 49570 361.97 343.87 395.45 49324 351.12 333.56 383.59 49572 442.82 420.68 483.78 49325 376.95 358.10 411.82 49580 281.30 267.24 307.33 49326 170.07 161.57 185.81 49582 415.36 394.59 453.78 49400 184.85 175.61 201.95 49585 387.57 368.19 423.42 # 49400 94.28 89.57 103.01 49587 458.61 435.68 501.03 49402 753.95 716.25 823.69 49590 503.75 478.56 550.34 49419 409.12 388.66 446.96 49600 652.30 619.69 712.64 49420 128.68 122.25 140.59 49605 4,396.33 4,176.51 4,802.99 49421 352.74 335.10 385.37 49606 1,017.27 966.41 1,111.37 49422 352.05 334.45 384.62 49610 618.70 587.77 675.94 49423 624.64 593.41 682.42 49611 571.44 542.87 624.30 # 49423 74.92 71.17 81.85 49650 378.48 359.56 413.49 49424 170.12 161.61 185.85 49651 488.13 463.72 533.28 # 49424 39.53 37.55 43.18 49900 726.48 690.16 793.68 49425 684.93 650.68 748.28 49904 1,399.99 1,329.99 1,529.49 49426 583.68 554.50 637.68 49905 327.22 310.86 357.49 49427 45.07 42.82 49.24 50010 689.40 654.93 753.17 49428 399.08 379.13 436.00 50020 986.28 936.97 1,077.52 49429 416.24 395.43 454.74 50021 1,020.94 969.89 1,115.37 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 42 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 50021 168.77 160.33 184.38 50500 1,131.75 1,075.16 1,236.43 50040 916.80 870.96 1,001.60 50520 1,028.43 977.01 1,123.56 50045 910.65 865.12 994.89 50525 1,310.94 1,245.39 1,432.20 50060 1,136.42 1,079.60 1,241.54 50526 1,321.11 1,255.05 1,443.31 50065 1,167.02 1,108.67 1,274.97 50540 1,147.31 1,089.94 1,253.43 50070 1,187.65 1,128.27 1,297.51 50541 919.69 873.71 1,004.77 50075 1,456.09 1,383.29 1,590.78 50542 1,163.88 1,105.69 1,271.54 50080 871.10 827.55 951.68 50543 1,483.86 1,409.67 1,621.12 50081 1,274.98 1,211.23 1,392.91 50544 1,253.62 1,190.94 1,369.58 50100 947.36 899.99 1,034.99 50545 1,342.58 1,275.45 1,466.77 50120 946.81 899.47 1,034.39 50546 1,193.69 1,134.01 1,304.11 50125 990.96 941.41 1,082.62 50547 1,466.03 1,392.73 1,601.64 50130 1,029.79 978.30 1,125.05 50548 1,353.46 1,285.79 1,478.66 50135 1,119.46 1,063.49 1,223.01 50551 384.77 365.53 420.36 50200 146.01 138.71 159.52 # 50551 298.00 283.10 325.57 50205 672.07 638.47 734.24 50553 400.42 380.40 437.46 50220 1,019.40 968.43 1,113.69 # 50553 314.91 299.16 344.03 50225 1,182.60 1,123.47 1,291.99 50555 442.15 420.04 483.05 50230 1,272.01 1,208.41 1,389.67 # 50555 346.53 329.20 378.58 50234 1,294.78 1,230.04 1,414.55 50557 444.56 422.33 485.68 50236 1,465.14 1,391.88 1,600.66 # 50557 350.20 332.69 382.59 50240 1,312.62 1,246.99 1,434.04 50561 501.58 476.50 547.98 50250 1,222.02 1,160.92 1,335.06 # 50561 399.64 379.66 436.61 50280 939.84 892.85 1,026.78 50562 593.96 564.26 648.90 50290 881.75 837.66 963.31 50570 497.19 472.33 543.18 50320 1,306.82 1,241.48 1,427.70 50572 539.20 512.24 589.08 50323 181.98 172.88 198.81 50574 574.60 545.87 627.75 50325 181.98 172.88 198.81 50575 723.88 687.69 790.84 50327 195.09 185.34 213.14 50576 571.64 543.06 624.52 50328 171.42 162.85 187.28 50580 615.73 584.94 672.68 50329 166.17 157.86 181.54 50590 966.44 918.12 1,055.84 50340 818.94 777.99 894.69 # 50590 560.78 532.74 612.65 50360 2,200.14 2,090.13 2,403.65 50592 4,972.45 4,723.83 5,432.40 50365 2,468.11 2,344.70 2,696.41 # 50592 367.43 349.06 401.42 50370 1,025.43 974.16 1,120.28 50593 5,152.49 4,894.87 5,629.10 50380 1,671.83 1,588.24 1,826.48 # 50593 469.54 446.06 512.97 50382 1,512.63 1,437.00 1,652.55 50600 929.28 882.82 1,015.24 # 50382 278.39 264.47 304.14 50605 914.04 868.34 998.59 50384 1,355.84 1,288.05 1,481.26 50610 956.97 909.12 1,045.49 # 50384 253.03 240.38 276.44 50620 903.01 857.86 986.54 50385 1,448.74 1,376.30 1,582.75 50630 880.74 836.70 962.21 # 50385 244.41 232.19 267.02 50650 1,029.25 977.79 1,124.46 50386 933.97 887.27 1,020.36 50660 1,139.74 1,082.75 1,245.16 # 50386 185.42 176.15 202.57 50684 215.49 204.72 235.43 50387 720.65 684.62 787.31 # 50684 50.36 47.84 55.02 # 50387 100.59 95.56 109.89 50686 175.20 166.44 191.41 50389 448.75 426.31 490.26 # 50686 88.85 84.41 97.07 # 50389 55.73 52.94 60.88 50688 84.53 80.30 92.35 50390 98.17 93.26 107.25 50690 110.30 104.79 120.51 50391 132.89 126.25 145.19 # 50690 71.97 68.37 78.63 # 50391 98.77 93.83 107.90 50700 931.35 884.78 1,017.50 50392 183.93 174.73 200.94 50715 1,120.00 1,064.00 1,223.60 50393 223.31 212.14 243.96 50722 975.87 927.08 1,066.14 50394 123.24 117.08 134.64 50725 1,077.99 1,024.09 1,177.70 # 50394 53.31 50.64 58.24 50727 504.67 479.44 551.36 50395 184.65 175.42 201.73 50728 694.44 659.72 758.68 50396 119.96 113.96 131.05 50740 1,083.51 1,029.33 1,183.73 50398 645.28 613.02 704.97 50750 1,154.27 1,096.56 1,261.04 # 50398 74.92 71.17 81.85 50760 1,089.03 1,034.58 1,189.77 50400 1,151.13 1,093.57 1,257.61 50770 1,152.15 1,094.54 1,258.72 50405 1,382.93 1,313.78 1,510.85 50780 1,086.95 1,032.60 1,187.49 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 43 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 50782 1,100.19 1,045.18 1,201.96 51595 2,176.51 2,067.68 2,377.83 50783 1,138.98 1,082.03 1,244.33 51596 2,337.00 2,220.15 2,553.17 50785 1,199.35 1,139.38 1,310.29 51597 2,261.15 2,148.09 2,470.30 50800 913.15 867.49 997.61 51600 226.79 215.45 247.77 50810 1,239.57 1,177.59 1,354.23 # 51600 44.39 42.17 48.50 50815 1,210.51 1,149.98 1,322.48 51605 39.11 37.15 42.72 50820 1,295.68 1,230.90 1,415.54 51610 125.84 119.55 137.48 50825 1,640.22 1,558.21 1,791.94 # 51610 64.76 61.52 70.75 50830 1,790.60 1,701.07 1,956.23 51700 96.62 91.79 105.56 50840 1,222.32 1,161.20 1,335.38 # 51700 44.39 42.17 48.50 50845 1,238.72 1,176.78 1,353.30 51701 73.26 69.60 80.04 50860 944.14 896.93 1,031.47 # 51701 27.34 25.97 29.87 50900 834.38 792.66 911.56 51702 94.32 89.60 103.04 50920 876.79 832.95 957.89 # 51702 30.29 28.78 33.10 50930 1,083.05 1,028.90 1,183.24 51703 157.78 149.89 172.37 50940 869.54 826.06 949.97 # 51703 81.12 77.06 88.62 50945 988.18 938.77 1,079.59 51705 127.57 121.19 139.37 50947 1,393.63 1,323.95 1,522.54 # 51705 67.75 64.36 74.01 50948 1,270.03 1,206.53 1,387.51 51710 181.56 172.48 198.35 50951 401.13 381.07 438.23 # 51710 94.78 90.04 103.55 # 50951 310.56 295.03 339.28 51715 309.73 294.24 338.38 50953 420.17 399.16 459.03 # 51715 199.36 189.39 217.80 # 50953 340.98 323.93 372.52 51720 125.59 119.31 137.21 50955 485.69 461.41 530.62 # 51720 84.73 80.49 92.56 # 50955 371.53 352.95 405.89 51725 262.64 249.51 286.94 50957 452.72 430.08 494.59 51725 TC 186.12 176.81 203.33 # 50957 359.62 341.64 392.89 51725 26 76.51 72.68 83.58 50961 408.00 387.60 445.74 51726 371.24 352.68 405.58 # 50961 321.22 305.16 350.93 51726 TC 284.15 269.94 310.43 50970 376.50 357.68 411.33 51726 26 87.09 82.74 95.15 50972 363.37 345.20 396.98 51736 54.52 51.79 59.56 50974 473.60 449.92 517.41 51736 TC 23.05 21.90 25.19 50976 470.44 446.92 513.96 51736 26 31.48 29.91 34.40 50980 361.12 343.06 394.52 51741 85.04 80.79 92.91 51020 464.14 440.93 507.07 51741 TC 26.72 25.38 29.19 51030 463.27 440.11 506.13 51741 26 58.32 55.40 63.71 51040 294.93 280.18 322.21 51772 284.56 270.33 310.88 51045 466.10 442.80 509.22 51772 TC 202.43 192.31 221.16 51050 469.19 445.73 512.59 51772 26 82.13 78.02 89.72 51060 580.34 551.32 634.02 51784 227.18 215.82 248.19 51065 573.90 545.21 626.99 51784 TC 149.48 142.01 163.31 51080 407.55 387.17 445.25 51784 26 77.70 73.82 84.89 51100 66.72 63.38 72.89 51785 245.83 233.54 268.57 # 51100 39.34 37.37 42.98 51785 TC 168.43 160.01 184.01 51101 139.04 132.09 151.90 51785 26 77.40 73.53 84.56 # 51101 51.84 49.25 56.64 51792 275.72 261.93 301.22 51102 352.69 335.06 385.32 51792 TC 219.57 208.59 239.88 # 51102 252.44 239.82 275.79 51792 26 56.15 53.34 61.34 51500 626.46 595.14 684.41 51795 353.24 335.58 385.92 51520 592.52 562.89 647.32 51795 TC 275.54 261.76 301.02 51525 853.42 810.75 932.36 51795 26 77.70 73.82 84.89 51530 766.94 728.59 837.88 51797 205.07 194.82 224.04 51535 786.02 746.72 858.73 51797 TC 157.36 149.49 171.91 51550 942.07 894.97 1,029.22 51797 26 47.72 45.33 52.13 51555 1,250.43 1,187.91 1,366.10 51798 22.20 21.09 24.25 51565 1,286.38 1,222.06 1,405.37 51800 1,036.35 984.53 1,132.21 51570 1,463.44 1,390.27 1,598.81 51820 1,087.88 1,033.49 1,188.51 51575 1,813.20 1,722.54 1,980.92 51840 651.05 618.50 711.28 51580 1,887.65 1,793.27 2,062.26 51841 775.51 736.73 847.24 51585 2,099.71 1,994.72 2,293.93 51845 587.56 558.18 641.91 51590 1,918.05 1,822.15 2,095.47 51860 719.94 683.94 786.53 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 44 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 51865 882.85 838.71 964.52 52330 1,428.84 1,357.40 1,561.01 51880 468.27 444.86 511.59 # 52330 267.05 253.70 291.76 51900 820.99 779.94 896.93 52332 484.28 460.07 529.08 51920 771.47 732.90 842.84 # 52332 156.56 148.73 171.04 51925 1,089.92 1,035.42 1,190.73 52334 258.62 245.69 282.54 51940 1,595.56 1,515.78 1,743.15 52341 330.02 313.52 360.55 51960 1,374.66 1,305.93 1,501.82 52342 354.95 337.20 387.78 51980 707.76 672.37 773.23 52343 390.34 370.82 426.44 51990 744.06 706.86 812.89 52344 421.47 400.40 460.46 51992 809.15 768.69 883.99 52345 446.83 424.49 488.16 52000 225.96 214.66 246.86 52346 499.03 474.08 545.19 # 52000 122.76 116.62 134.11 52351 317.23 301.37 346.58 52001 408.55 388.12 446.34 52352 372.26 353.65 406.70 # 52001 288.92 274.47 315.64 52353 428.32 406.90 467.94 52005 323.26 307.10 353.17 52354 396.08 376.28 432.72 # 52005 132.86 126.22 145.15 52355 471.95 448.35 515.60 52007 680.66 646.63 743.62 52400 552.28 524.67 603.37 # 52007 166.75 158.41 182.17 52402 270.83 257.29 295.88 52010 505.13 479.87 551.85 52450 466.85 443.51 510.04 # 52010 166.45 158.13 181.85 52500 547.90 520.51 598.59 52204 573.18 544.52 626.20 52601 821.71 780.62 897.71 # 52204 140.56 133.53 153.56 52606 505.88 480.59 552.68 52214 1,354.85 1,287.11 1,480.18 52612 525.85 499.56 574.49 # 52214 199.38 189.41 217.82 52614 461.92 438.82 504.64 52224 1,282.62 1,218.49 1,401.26 52620 416.94 396.09 455.50 # 52224 170.97 162.42 186.78 52630 441.87 419.78 482.75 52234 248.55 236.12 271.54 52640 402.33 382.21 439.54 52235 291.87 277.28 318.87 52647 2,840.45 2,698.43 3,103.19 52240 509.52 484.04 556.65 # 52647 639.04 607.09 698.15 52250 244.07 231.87 266.65 52648 2,882.39 2,738.27 3,149.01 52260 210.68 200.15 230.17 # 52648 681.82 647.73 744.89 52265 544.86 517.62 595.26 52649 1,005.39 955.12 1,098.39 # 52265 160.27 152.26 175.10 52700 434.25 412.54 474.42 52270 501.10 476.05 547.46 53000 152.58 144.95 166.69 # 52270 183.49 174.32 200.47 53010 296.05 281.25 323.44 52275 691.90 657.31 755.91 53020 97.85 92.96 106.90 # 52275 250.86 238.32 274.07 53025 68.55 65.12 74.89 52276 267.75 254.36 292.51 53040 398.00 378.10 434.82 52277 328.90 312.46 359.33 53060 185.80 176.51 202.99 52281 361.48 343.41 394.92 # 53060 158.84 150.90 173.54 # 52281 155.91 148.11 170.33 53080 476.09 452.29 520.13 52282 338.94 321.99 370.29 53085 649.71 617.22 709.80 52283 302.09 286.99 330.04 53200 157.05 149.20 171.58 # 52283 201.83 191.74 220.50 # 53200 141.46 134.39 154.55 52285 305.03 289.78 333.25 53210 772.21 733.60 843.64 # 52285 195.93 186.13 214.05 53215 929.48 883.01 1,015.46 52290 246.30 233.99 269.09 53220 452.21 429.60 494.04 52300 284.44 270.22 310.75 53230 603.50 573.33 659.33 52301 297.57 282.69 325.09 53235 637.20 605.34 696.14 52305 281.91 267.81 307.98 53240 428.38 406.96 468.00 52310 283.97 269.77 310.24 53250 393.14 373.48 429.50 # 52310 152.54 144.91 166.65 53260 207.74 197.35 226.95 52315 509.00 483.55 556.08 # 53260 177.41 168.54 193.82 # 52315 277.32 263.45 302.97 53265 232.22 220.61 253.70 52317 1,210.34 1,149.82 1,322.29 # 53265 185.04 175.79 202.16 # 52317 352.27 334.66 384.86 53270 212.23 201.62 231.86 52318 479.76 455.77 524.14 # 53270 185.27 176.01 202.41 52320 249.17 236.71 272.22 53275 268.74 255.30 293.60 52325 324.27 308.06 354.27 53400 800.59 760.56 874.64 52327 899.57 854.59 982.78 53405 872.81 829.17 953.55 # 52327 267.28 253.92 292.01 53410 979.11 930.15 1,069.67 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 45 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 53415 1,114.80 1,059.06 1,217.92 # 54105 217.84 206.95 237.99 53420 818.81 777.87 894.55 54110 627.73 596.34 685.79 53425 940.57 893.54 1,027.57 54111 801.92 761.82 876.09 53430 951.38 903.81 1,039.38 54112 940.77 893.73 1,027.79 53431 1,153.60 1,095.92 1,260.31 54115 456.96 434.11 499.23 53440 866.23 822.92 946.36 # 54115 420.32 399.30 459.20 53442 763.97 725.77 834.64 54120 627.92 596.52 686.00 53444 795.76 755.97 869.37 54125 808.71 768.27 883.51 53445 876.85 833.01 957.96 54130 1,192.73 1,133.09 1,303.05 53446 646.77 614.43 706.59 54135 1,513.16 1,437.50 1,653.13 53447 818.08 777.18 893.76 54150 200.70 190.67 219.27 53448 1,280.75 1,216.71 1,399.22 # 54150 99.60 94.62 108.81 53449 610.89 580.35 667.40 54160 257.31 244.44 281.11 53450 407.36 386.99 445.04 # 54160 143.99 136.79 157.31 53460 457.57 434.69 499.89 54161 197.31 187.44 215.56 53500 748.39 710.97 817.62 54162 299.15 284.19 326.82 53502 485.59 461.31 530.51 # 54162 194.68 184.95 212.69 53505 486.56 462.23 531.56 54163 219.11 208.15 239.37 53510 640.82 608.78 700.10 54164 193.76 184.07 211.68 53515 800.20 760.19 874.22 54200 119.29 113.33 130.33 53520 558.88 530.94 610.58 # 54200 86.86 82.52 94.90 53600 91.76 87.17 100.25 54205 541.38 514.31 591.46 # 53600 64.80 61.56 70.79 54220 237.59 225.71 259.57 53601 90.69 86.16 99.08 # 54220 135.23 128.47 147.74 # 53601 53.62 50.94 58.58 54230 100.19 95.18 109.46 53605 65.41 62.14 71.46 # 54230 80.39 76.37 87.83 53620 136.07 129.27 148.66 54231 144.18 136.97 157.52 # 53620 88.05 83.65 96.20 # 54231 118.48 112.56 129.44 53621 130.36 123.84 142.42 54235 91.95 87.35 100.45 # 53621 73.07 69.42 79.83 # 54235 73.42 69.75 80.21 53660 80.84 76.80 88.32 54240 102.28 97.17 111.75 # 53660 41.67 39.59 45.53 54240 TC 35.92 34.12 39.24 53661 80.42 76.40 87.86 54240 26 66.36 63.04 72.50 # 53661 40.40 38.38 44.14 54250 124.84 118.60 136.39 53665 38.45 36.53 42.01 54250 TC 12.39 11.77 13.54 53850 3,376.68 3,207.85 3,689.03 54250 26 112.44 106.82 122.84 # 53850 563.62 535.44 615.76 54300 655.37 622.60 715.99 53852 3,229.10 3,067.65 3,527.80 54304 767.91 729.51 838.94 # 53852 613.61 582.93 670.37 54308 672.85 639.21 735.09 53853 1,977.58 1,878.70 2,160.51 54312 856.39 813.57 935.61 # 53853 349.90 332.41 382.27 54316 1,017.31 966.44 1,111.41 54000 173.79 165.10 189.87 54318 679.95 645.95 742.84 # 54000 106.39 101.07 116.23 54322 798.78 758.84 872.67 54001 210.71 200.17 230.20 54324 994.55 944.82 1,086.54 # 54001 137.84 130.95 150.59 54326 960.00 912.00 1,048.80 54015 312.59 296.96 341.50 54328 946.87 899.53 1,034.46 54050 124.16 117.95 135.64 54332 1,026.37 975.05 1,121.31 # 54050 95.94 91.14 104.81 54336 1,161.05 1,103.00 1,268.45 54055 118.38 112.46 129.33 54340 582.70 553.57 636.61 # 54055 86.79 82.45 94.82 54344 981.20 932.14 1,071.96 54056 129.88 123.39 141.90 54348 1,039.33 987.36 1,135.46 # 54056 100.40 95.38 109.69 54352 1,474.17 1,400.46 1,610.53 54057 147.21 139.85 160.83 54360 736.36 699.54 804.47 # 54057 91.61 87.03 100.08 54380 809.89 769.40 884.81 54060 200.45 190.43 218.99 54385 990.81 941.27 1,082.46 # 54060 126.73 120.39 138.45 54390 1,163.70 1,105.52 1,271.35 54065 211.47 200.90 231.04 54400 538.74 511.80 588.57 # 54065 154.18 146.47 168.44 54401 660.56 627.53 721.66 54100 196.79 186.95 214.99 54405 810.13 769.62 885.06 # 54100 112.96 107.31 123.41 54406 731.10 694.55 798.73 54105 299.98 284.98 327.73 54408 785.12 745.86 857.74 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 46 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 54410 925.63 879.35 1,011.25 55540 474.43 450.71 518.32 54411 1,013.70 963.02 1,107.47 55550 421.92 400.82 460.94 54415 527.93 501.53 576.76 55600 424.90 403.66 464.21 54416 703.58 668.40 768.66 55605 498.12 473.21 544.19 54417 889.87 845.38 972.19 55650 717.26 681.40 783.61 54420 711.46 675.89 777.27 55680 348.12 330.71 380.32 54430 644.55 612.32 704.17 55700 256.75 243.91 280.50 54435 420.69 399.66 459.61 # 55700 131.64 125.06 143.82 54450 78.28 74.37 85.53 55705 272.42 258.80 297.62 # 54450 59.75 56.76 65.27 55720 470.60 447.07 514.13 54500 74.91 71.16 81.83 55725 582.05 552.95 635.89 54505 217.29 206.43 237.39 55801 1,080.77 1,026.73 1,180.74 54512 538.31 511.39 588.10 55810 1,311.56 1,245.98 1,432.88 54520 329.08 312.63 359.52 55812 1,594.74 1,515.00 1,742.25 54522 589.45 559.98 643.98 55815 1,762.17 1,674.06 1,925.17 54530 551.22 523.66 602.21 55821 871.00 827.45 951.57 54535 731.55 694.97 799.22 55831 943.51 896.33 1,030.78 54550 488.41 463.99 533.59 55840 1,336.54 1,269.71 1,460.17 54560 684.39 650.17 747.70 55842 1,431.26 1,359.70 1,563.66 54600 452.35 429.73 494.19 55845 1,634.77 1,553.03 1,785.98 54620 304.43 289.21 332.59 55860 875.67 831.89 956.67 54640 465.65 442.37 508.73 55862 1,107.11 1,051.75 1,209.51 54650 681.17 647.11 744.18 55865 1,328.90 1,262.46 1,451.83 54660 358.40 340.48 391.55 55866 1,736.87 1,650.03 1,897.53 54670 411.39 390.82 449.44 55870 176.53 167.70 192.86 54680 796.10 756.30 869.75 # 55870 145.36 138.09 158.80 54690 643.74 611.55 703.28 55873 1,151.09 1,093.54 1,257.57 54692 772.98 734.33 844.48 55875 764.31 726.09 835.00 54700 215.59 204.81 235.53 55876 153.89 146.20 168.13 54800 130.17 123.66 142.21 # 55876 110.92 105.37 121.18 54830 368.43 350.01 402.51 55920 430.40 408.88 470.21 54840 326.11 309.80 356.27 56405 107.23 101.87 117.15 54860 417.05 396.20 455.63 # 56405 103.01 97.86 112.54 54861 564.62 536.39 616.85 56420 132.39 125.77 144.64 54865 355.02 337.27 387.86 # 56420 90.69 86.16 99.08 54900 734.84 698.10 802.82 56440 175.50 166.73 191.74 54901 1,073.36 1,019.69 1,172.64 56441 147.25 139.89 160.87 55000 134.19 127.48 146.60 # 56441 135.46 128.69 147.99 # 55000 84.48 80.26 92.30 56442 46.89 44.55 51.23 55040 339.13 322.17 370.50 56501 129.59 123.11 141.58 55041 505.22 479.96 551.95 # 56501 109.37 103.90 119.49 55060 376.60 357.77 411.44 56515 216.34 205.52 236.35 55100 236.83 224.99 258.74 # 56515 187.28 177.92 204.61 # 55100 163.11 154.95 178.19 56605 83.22 79.06 90.92 55110 383.52 364.34 418.99 # 56605 57.95 55.05 63.31 55120 352.35 334.73 384.94 56606 38.62 36.69 42.19 55150 482.64 458.51 527.29 # 56606 28.51 27.08 31.14 55175 360.52 342.49 393.86 56620 505.29 480.03 552.03 55180 685.94 651.64 749.39 56625 566.28 537.97 618.67 55200 590.18 560.67 644.77 56630 816.53 775.70 892.06 # 55200 281.40 267.33 307.43 56631 1,043.52 991.34 1,140.04 55250 525.98 499.68 574.63 56632 1,197.90 1,138.01 1,308.71 # 55250 230.69 219.16 252.03 56633 1,062.53 1,009.40 1,160.81 55300 190.07 180.57 207.66 56634 1,127.67 1,071.29 1,231.98 55400 506.47 481.15 553.32 56637 1,337.45 1,270.58 1,461.17 55450 419.17 398.21 457.94 56640 1,329.15 1,262.69 1,452.09 # 55450 250.25 237.74 273.40 56700 179.17 170.21 195.74 55500 376.54 357.71 411.37 56740 282.99 268.84 309.17 55520 392.86 373.22 429.20 56800 232.36 220.74 253.85 55530 355.18 337.42 388.03 56805 1,091.58 1,037.00 1,192.55 55535 426.55 405.22 466.00 56810 249.92 237.42 273.03 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 47 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 56820 108.68 103.25 118.74 57300 499.69 474.71 545.92 # 56820 80.88 76.84 88.37 57305 829.00 787.55 905.68 56821 146.42 139.10 159.97 57307 928.23 881.82 1,014.09 # 56821 110.61 105.08 120.84 57308 600.06 570.06 655.57 57000 183.04 173.89 199.97 57310 457.85 434.96 500.20 57010 409.17 388.71 447.02 57311 519.72 493.73 567.79 57020 92.25 87.64 100.79 57320 520.19 494.18 568.31 # 57020 77.93 74.03 85.13 57330 746.50 709.18 815.56 57022 160.58 152.55 175.43 57335 1,083.85 1,029.66 1,184.11 57023 294.79 280.05 322.06 57400 128.73 122.29 140.63 57061 114.43 108.71 125.02 57410 102.37 97.25 111.84 # 57061 94.63 89.90 103.39 57415 151.16 143.60 165.14 57065 189.26 179.80 206.77 57420 114.11 108.40 124.66 # 57065 164.83 156.59 180.08 # 57420 85.47 81.20 93.38 57100 87.82 83.43 95.94 57421 154.95 147.20 169.28 # 57100 62.54 59.41 68.32 # 57421 117.88 111.99 128.79 57105 135.10 128.35 147.60 57423 864.51 821.28 944.47 # 57105 121.62 115.54 132.87 57425 909.79 864.30 993.95 57106 448.21 425.80 489.67 57452 107.83 102.44 117.81 57107 1,317.65 1,251.77 1,439.54 # 57452 87.62 83.24 95.73 57109 1,503.59 1,428.41 1,642.67 57454 151.05 143.50 165.03 57110 854.96 812.21 934.04 # 57454 131.25 124.69 143.39 57111 1,535.25 1,458.49 1,677.26 57455 142.13 135.02 155.27 57112 1,596.43 1,516.61 1,744.10 # 57455 106.33 101.01 116.16 57120 488.17 463.76 533.32 57456 134.40 127.68 146.83 57130 177.93 169.03 194.38 # 57456 99.44 94.47 108.64 # 57130 154.34 146.62 168.61 57460 318.84 302.90 348.34 57135 190.37 180.85 207.98 # 57460 157.50 149.63 172.07 # 57135 166.78 158.44 182.21 57461 353.06 335.41 385.72 57150 55.89 53.10 61.07 # 57461 181.19 172.13 197.95 # 57150 28.09 26.69 30.69 57500 140.29 133.28 153.27 57155 412.00 391.40 450.11 # 57500 71.21 67.65 77.80 57160 76.30 72.49 83.36 57505 101.87 96.78 111.30 # 57160 45.55 43.27 49.76 # 57505 88.81 84.37 97.03 57170 76.95 73.10 84.07 57510 131.18 124.62 143.31 # 57170 46.20 43.89 50.47 # 57510 111.81 106.22 122.15 57180 144.44 137.22 157.80 57511 143.74 136.55 157.03 # 57180 105.69 100.41 115.47 # 57511 127.32 120.95 139.09 57200 284.14 269.93 310.42 57513 140.80 133.76 153.82 57210 349.93 332.43 382.29 # 57513 128.16 121.75 140.01 57220 305.27 290.01 333.51 57520 306.17 290.86 334.49 57230 374.64 355.91 409.30 # 57520 265.31 252.04 289.85 57240 600.30 570.29 655.83 57522 259.33 246.36 283.31 57250 586.88 557.54 641.17 # 57522 233.63 221.95 255.24 57260 739.19 702.23 807.56 57530 329.14 312.68 359.58 57265 835.69 793.91 913.00 57531 1,612.38 1,531.76 1,761.52 57267 257.40 244.53 281.21 57540 736.34 699.52 804.45 57268 455.50 432.73 497.64 57545 779.63 740.65 851.75 57270 755.32 717.55 825.18 57550 387.35 367.98 423.18 57280 913.88 868.19 998.42 57555 572.45 543.83 625.40 57282 484.77 460.53 529.61 57556 539.41 512.44 589.31 57283 654.31 621.59 714.83 57558 122.54 116.41 133.87 57284 800.36 760.34 874.39 # 57558 109.06 103.61 119.15 57285 625.15 593.89 682.97 57700 289.34 274.87 316.10 57287 664.49 631.27 725.96 57720 294.93 280.18 322.21 57288 778.98 740.03 851.03 57800 59.95 56.95 65.49 57289 733.01 696.36 800.81 # 57800 47.31 44.94 51.68 57291 523.13 496.97 571.52 58100 108.99 103.54 119.07 57292 787.63 748.25 860.49 # 58100 84.55 80.32 92.37 57295 468.30 444.89 511.62 58110 48.58 46.15 53.07 57296 887.07 842.72 969.13 # 58110 39.73 37.74 43.40 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 48 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 58120 236.66 224.83 258.55 58559 330.73 314.19 361.32 # 58120 205.91 195.61 224.95 58560 375.17 356.41 409.87 58140 864.31 821.09 944.25 58561 529.64 503.16 578.63 58145 516.68 490.85 564.48 58562 318.39 302.47 347.84 58146 1,097.88 1,042.99 1,199.44 # 58562 280.90 266.86 306.89 58150 932.61 885.98 1,018.88 58563 2,198.94 2,088.99 2,402.34 58152 1,185.44 1,126.17 1,295.10 # 58563 331.16 314.60 361.79 58180 896.67 851.84 979.62 58565 2,203.10 2,092.95 2,406.89 58200 1,235.16 1,173.40 1,349.41 # 58565 427.56 406.18 467.11 58210 1,644.12 1,561.91 1,796.20 58570 858.64 815.71 938.07 58240 2,525.17 2,398.91 2,758.75 58571 939.96 892.96 1,026.90 58260 783.58 744.40 856.06 58572 1,063.64 1,010.46 1,162.03 58262 874.70 830.97 955.62 58573 1,199.30 1,139.34 1,310.24 58263 941.88 894.79 1,029.01 58600 349.54 332.06 381.87 58267 1,000.72 950.68 1,093.28 58605 317.46 301.59 346.83 58270 839.52 797.54 917.17 58611 74.71 70.97 81.62 58275 931.13 884.57 1,017.26 58615 245.86 233.57 268.61 58280 997.00 947.15 1,089.22 58660 637.20 605.34 696.14 58285 1,244.84 1,182.60 1,359.99 58661 613.45 582.78 670.20 58290 1,097.20 1,042.34 1,198.69 58662 672.94 639.29 735.18 58291 1,190.39 1,130.87 1,300.50 58670 348.99 331.54 381.27 58292 1,256.76 1,193.92 1,373.01 58671 349.29 331.83 381.60 58293 1,306.07 1,240.77 1,426.89 58672 713.73 678.04 779.75 58294 1,155.76 1,097.97 1,262.67 58673 769.90 731.41 841.12 58301 97.16 92.30 106.15 58700 720.83 684.79 787.51 # 58301 64.72 61.48 70.70 58720 678.48 644.56 741.24 58321 77.87 73.98 85.08 58740 828.52 787.09 905.15 # 58321 46.70 44.37 51.03 58750 863.55 820.37 943.43 58322 88.28 83.87 96.45 58752 852.24 809.63 931.07 # 58322 56.26 53.45 61.47 58760 780.93 741.88 853.16 58323 22.89 21.75 25.01 58770 815.10 774.35 890.50 # 58323 11.94 11.34 13.04 58800 310.79 295.25 339.54 58340 144.28 137.07 157.63 # 58800 284.25 270.04 310.55 # 58340 57.93 55.03 63.28 58805 382.13 363.02 417.47 58345 265.54 252.26 290.10 58820 302.27 287.16 330.23 58346 430.87 409.33 470.73 58822 648.82 616.38 708.84 58350 98.32 93.40 107.41 58823 991.81 942.22 1,083.55 # 58350 76.41 72.59 83.48 # 58823 169.13 160.67 184.77 58353 1,365.87 1,297.58 1,492.22 58825 658.71 625.77 719.64 # 58353 212.51 201.88 232.16 58900 390.41 370.89 426.52 58356 2,447.93 2,325.53 2,674.36 58920 667.34 633.97 729.07 # 58356 334.98 318.23 365.96 58925 689.20 654.74 752.95 58400 425.32 404.05 464.66 58940 472.95 449.30 516.70 58410 758.33 720.41 828.47 58943 1,055.89 1,003.10 1,153.57 58520 738.50 701.58 806.82 58950 1,006.82 956.48 1,099.95 58540 856.93 814.08 936.19 58951 1,295.94 1,231.14 1,415.81 58541 800.66 760.63 874.72 58952 1,462.38 1,389.26 1,597.65 58542 885.34 841.07 967.23 58953 1,813.66 1,722.98 1,981.43 58543 899.84 854.85 983.08 58954 1,968.88 1,870.44 2,151.01 58544 972.11 923.50 1,062.03 58956 1,283.43 1,219.26 1,402.15 58545 850.00 807.50 928.63 58957 1,371.77 1,303.18 1,498.66 58546 1,075.85 1,022.06 1,175.37 58958 1,516.49 1,440.67 1,656.77 58548 1,692.81 1,608.17 1,849.40 58960 870.06 826.56 950.54 58550 840.01 798.01 917.71 58970 219.40 208.43 239.69 58552 925.81 879.52 1,011.45 # 58970 189.92 180.42 207.48 58553 1,080.49 1,026.47 1,180.44 58976 240.26 228.25 262.49 58554 1,237.22 1,175.36 1,351.66 # 58976 206.56 196.23 225.66 58555 228.83 217.39 250.00 59000 133.47 126.80 145.82 # 58555 182.92 173.77 199.84 # 59000 78.71 74.77 85.99 58558 299.18 284.22 326.85 59001 174.77 166.03 190.93 # 58558 257.48 244.61 281.30 59012 197.24 187.38 215.49 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 49 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 59015 152.34 144.72 166.43 # 59821 339.61 322.63 371.02 # 59015 128.75 122.31 140.66 59830 419.21 398.25 457.99 59020 68.79 65.35 75.15 59840 209.69 199.21 229.09 59020 TC 32.48 30.86 35.49 # 59840 205.06 194.81 224.03 59020 26 36.31 34.49 39.66 59841 364.11 345.90 397.79 59025 45.27 43.01 49.46 # 59841 341.36 324.29 372.93 59025 TC 15.76 14.97 17.22 59850 358.28 340.37 391.43 59025 26 29.51 28.03 32.23 59851 386.05 366.75 421.76 59030 106.90 101.56 116.79 59852 518.93 492.98 566.93 59050 49.27 46.81 53.83 59855 398.44 378.52 435.30 59051 40.56 38.53 44.31 59856 470.66 447.13 514.20 59070 386.14 366.83 421.85 59857 550.74 523.20 601.68 # 59070 271.14 257.58 296.22 59866 229.36 217.89 250.57 59072 424.82 403.58 464.12 59870 445.49 423.22 486.70 59074 357.49 339.62 390.56 59871 130.06 123.56 142.09 # 59074 266.08 252.78 290.70 60000 149.38 141.91 163.20 59076 424.82 403.58 464.12 # 60000 136.32 129.50 148.93 59100 789.14 749.68 862.13 60100 112.83 107.19 123.27 59120 751.18 713.62 820.66 # 60100 77.45 73.58 84.62 59121 756.51 718.68 826.48 60200 606.89 576.55 663.03 59130 850.13 807.62 928.76 60210 642.24 610.13 701.65 59135 859.22 816.26 938.70 60212 917.52 871.64 1,002.39 59136 815.06 774.31 890.46 60220 703.51 668.33 768.58 59140 352.83 335.19 385.47 60225 846.30 803.99 924.59 59150 731.48 694.91 799.15 60240 896.74 851.90 979.69 59151 717.91 682.01 784.31 60252 1,206.51 1,146.18 1,318.11 59160 222.44 211.32 243.02 60254 1,568.18 1,489.77 1,713.24 # 59160 180.74 171.70 197.46 60260 1,010.45 959.93 1,103.92 59200 77.19 73.33 84.33 60270 1,265.79 1,202.50 1,382.88 # 59200 43.49 41.32 47.52 60271 976.54 927.71 1,066.87 59300 190.23 180.72 207.83 60280 413.12 392.46 451.33 # 59300 139.68 132.70 152.61 60281 551.11 523.55 602.08 59320 148.47 141.05 162.21 60300 105.05 99.80 114.77 59325 234.03 222.33 255.68 # 60300 48.18 45.77 52.64 59350 266.78 253.44 291.46 60500 924.39 878.17 1,009.90 59400 1,689.65 1,605.17 1,845.95 60502 1,164.37 1,106.15 1,272.07 59409 741.76 704.67 810.37 60505 1,281.01 1,216.96 1,399.50 59410 858.07 815.17 937.45 60512 225.24 213.98 246.08 59412 100.23 95.22 109.50 60520 964.65 916.42 1,053.88 59414 88.60 84.17 96.80 60521 1,102.40 1,047.28 1,204.37 59425 422.11 401.00 461.15 60522 1,327.11 1,260.75 1,449.86 # 59425 318.91 302.96 348.40 60540 990.92 941.37 1,082.58 59426 755.24 717.48 825.10 60545 1,133.53 1,076.85 1,238.38 # 59426 563.15 534.99 615.24 60600 1,327.14 1,260.78 1,449.90 59430 135.53 128.75 148.06 60605 1,665.05 1,581.80 1,819.07 # 59430 121.63 115.55 132.88 60650 1,104.21 1,049.00 1,206.35 59510 1,912.67 1,817.04 2,089.60 61000 103.12 97.96 112.65 59514 876.87 833.03 957.98 61001 100.11 95.10 109.37 59515 1,034.55 982.82 1,130.24 61020 123.55 117.37 134.98 59525 463.59 440.41 506.47 61026 123.48 117.31 134.91 59610 1,777.79 1,688.90 1,942.24 61050 105.28 100.02 115.02 59612 831.51 789.93 908.42 61055 133.76 127.07 146.13 59614 930.53 884.00 1,016.60 61070 80.51 76.48 87.95 59618 2,000.40 1,900.38 2,185.44 61105 408.32 387.90 446.09 59620 956.55 908.72 1,045.03 61107 298.87 283.93 326.52 59622 1,123.41 1,067.24 1,227.33 61108 794.50 754.78 868.00 59812 295.69 280.91 323.05 61120 653.52 620.84 713.97 # 59812 280.11 266.10 306.02 61140 1,128.66 1,072.23 1,233.06 59820 365.52 347.24 399.33 61150 1,208.19 1,147.78 1,319.95 # 59820 334.35 317.63 365.27 61151 885.65 841.37 967.58 59821 372.05 353.45 406.47 61154 1,125.64 1,069.36 1,229.76 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 50 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 61156 1,125.58 1,069.30 1,229.70 61550 815.95 775.15 891.42 61210 348.29 330.88 380.51 61552 1,164.59 1,106.36 1,272.31 61215 431.43 409.86 471.34 61556 1,469.18 1,395.72 1,605.08 61250 768.41 729.99 839.49 61557 1,530.04 1,453.54 1,671.57 61253 852.05 809.45 930.87 61558 1,539.26 1,462.30 1,681.65 61304 1,490.71 1,416.17 1,628.60 61559 2,191.29 2,081.73 2,393.99 61305 1,783.36 1,694.19 1,948.32 61563 1,709.56 1,624.08 1,867.69 61312 1,844.00 1,751.80 2,014.57 61564 2,193.88 2,084.19 2,396.82 61313 1,772.49 1,683.87 1,936.45 61566 2,024.52 1,923.29 2,211.78 61314 1,631.37 1,549.80 1,782.27 61567 2,277.65 2,163.77 2,488.34 61315 1,876.11 1,782.30 2,049.65 61570 1,655.68 1,572.90 1,808.84 61316 80.87 76.83 88.35 61571 1,786.14 1,696.83 1,951.35 61320 1,732.02 1,645.42 1,892.23 61575 2,143.21 2,036.05 2,341.46 61321 1,918.94 1,822.99 2,096.44 61576 3,352.10 3,184.50 3,662.18 61322 2,078.12 1,974.21 2,270.34 61580 2,281.08 2,167.03 2,492.08 61323 2,123.93 2,017.73 2,320.39 61581 2,511.21 2,385.65 2,743.50 61330 1,451.49 1,378.92 1,585.76 61582 2,613.26 2,482.60 2,854.99 61332 1,708.99 1,623.54 1,867.07 61583 2,647.77 2,515.38 2,892.69 61333 1,702.65 1,617.52 1,860.15 61584 2,580.78 2,451.74 2,819.50 61334 1,125.07 1,068.82 1,229.14 61585 2,732.41 2,595.79 2,985.16 61340 1,301.08 1,236.03 1,421.43 61586 2,005.09 1,904.84 2,190.57 61343 1,990.18 1,890.67 2,174.27 61590 2,868.00 2,724.60 3,133.29 61345 1,831.36 1,739.79 2,000.76 61591 2,892.81 2,748.17 3,160.40 61440 1,790.34 1,700.82 1,955.94 61592 2,876.56 2,732.73 3,142.64 61450 1,702.87 1,617.73 1,860.39 61595 2,169.23 2,060.77 2,369.89 61458 1,820.59 1,729.56 1,988.99 61596 2,385.93 2,266.63 2,606.62 61460 1,850.73 1,758.19 2,021.92 61597 2,615.47 2,484.70 2,857.41 61470 1,694.21 1,609.50 1,850.93 61598 2,356.69 2,238.86 2,574.69 61480 1,638.89 1,556.95 1,790.49 61600 1,954.33 1,856.61 2,135.10 61490 1,724.84 1,638.60 1,884.39 61601 2,150.08 2,042.58 2,348.97 61500 1,219.60 1,158.62 1,332.41 61605 2,052.77 1,950.13 2,242.65 61501 1,037.23 985.37 1,133.18 61606 2,716.05 2,580.25 2,967.29 61510 1,963.66 1,865.48 2,145.30 61607 2,529.22 2,402.76 2,763.17 61512 2,325.08 2,208.83 2,540.15 61608 2,971.74 2,823.15 3,246.62 61514 1,719.00 1,633.05 1,878.01 61609 581.01 551.96 634.75 61516 1,680.07 1,596.07 1,835.48 61610 1,740.97 1,653.92 1,902.01 61517 81.71 77.62 89.26 61611 423.36 402.19 462.52 61518 2,502.10 2,377.00 2,733.55 61612 1,484.97 1,410.72 1,622.33 61519 2,692.70 2,558.07 2,941.78 61613 2,900.71 2,755.67 3,169.02 61520 3,443.33 3,271.16 3,761.83 61615 2,272.89 2,159.25 2,483.14 61521 2,900.36 2,755.34 3,168.64 61616 2,999.41 2,849.44 3,276.86 61522 1,967.47 1,869.10 2,149.47 61618 1,178.75 1,119.81 1,287.78 61524 1,880.79 1,786.75 2,054.76 61619 1,365.50 1,297.23 1,491.81 61526 3,128.25 2,971.84 3,417.62 61623 531.74 505.15 580.92 61530 2,657.40 2,524.53 2,903.21 61624 1,037.04 985.19 1,132.97 61531 1,076.41 1,022.59 1,175.98 61626 840.11 798.10 917.82 61533 1,366.07 1,297.77 1,492.44 61680 2,052.43 1,949.81 2,242.28 61534 1,467.07 1,393.72 1,602.78 61682 3,873.90 3,680.21 4,232.24 61535 873.68 830.00 954.50 61684 2,603.09 2,472.94 2,843.88 61536 2,353.09 2,235.44 2,570.76 61686 4,148.15 3,940.74 4,531.85 61537 2,105.08 1,999.83 2,299.80 61690 1,961.74 1,863.65 2,143.20 61538 2,246.35 2,134.03 2,454.13 61692 3,332.71 3,166.07 3,640.98 61539 2,131.43 2,024.86 2,328.59 61697 3,713.70 3,528.02 4,057.22 61540 2,013.26 1,912.60 2,199.49 61698 3,928.45 3,732.03 4,291.83 61541 1,918.67 1,822.74 2,096.15 61700 3,185.79 3,026.50 3,480.48 61542 2,085.57 1,981.29 2,278.48 61702 3,473.13 3,299.47 3,794.39 61543 1,917.14 1,821.28 2,094.47 61703 1,186.00 1,126.70 1,295.71 61544 1,692.08 1,607.48 1,848.60 61705 2,339.93 2,222.93 2,556.37 61545 2,871.19 2,727.63 3,136.77 61708 1,959.80 1,861.81 2,141.08 61546 2,075.98 1,972.18 2,268.01 61710 1,767.00 1,678.65 1,930.45 61548 1,402.59 1,332.46 1,532.33 61711 2,378.33 2,259.41 2,598.32 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 51 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 61720 1,051.59 999.01 1,148.86 # 62263 358.77 340.83 391.95 61735 1,281.88 1,217.79 1,400.46 62264 438.68 416.75 479.26 61750 1,262.20 1,199.09 1,378.95 # 62264 213.31 202.64 233.04 61751 1,233.65 1,171.97 1,347.77 62268 557.00 529.15 608.52 61760 1,351.10 1,283.55 1,476.08 # 62268 256.23 243.42 279.93 61770 1,352.87 1,285.23 1,478.01 62269 621.27 590.21 678.74 61790 759.92 721.92 830.21 # 62269 253.10 240.45 276.52 61791 979.92 930.92 1,070.56 62270 162.12 154.01 177.11 61793 1,147.66 1,090.28 1,253.82 # 62270 72.82 69.18 79.56 61795 232.71 221.07 254.23 62272 192.99 183.34 210.84 61850 872.21 828.60 952.89 # 62272 78.84 74.90 86.14 61860 1,394.98 1,325.23 1,524.01 62273 168.64 160.21 184.24 61863 1,367.05 1,298.70 1,493.51 # 62273 103.34 98.17 112.90 61864 397.66 377.78 434.45 62280 341.45 324.38 373.04 61867 1,997.63 1,897.75 2,182.41 # 62280 143.47 136.30 156.75 61868 576.68 547.85 630.03 62281 300.59 285.56 328.39 61870 1,073.06 1,019.41 1,172.32 # 62281 135.88 129.09 148.45 61875 933.86 887.17 1,020.25 62282 345.73 328.44 377.71 61880 486.94 462.59 531.98 # 62282 126.69 120.36 138.41 61885 557.32 529.45 608.87 62284 240.56 228.53 262.81 61886 701.14 666.08 765.99 # 62284 85.54 81.26 93.45 61888 365.91 347.61 399.75 62287 524.98 498.73 573.54 62000 775.68 736.90 847.44 62290 353.31 335.64 385.99 62005 1,095.72 1,040.93 1,197.07 # 62290 161.22 153.16 176.13 62010 1,368.96 1,300.51 1,495.59 62291 320.39 304.37 350.03 62100 1,459.57 1,386.59 1,594.58 # 62291 154.42 146.70 168.71 62115 1,470.16 1,396.65 1,606.15 62292 487.92 463.52 533.05 62116 1,587.02 1,507.67 1,733.82 62294 723.08 686.93 789.97 62117 1,682.67 1,598.54 1,838.32 62310 232.32 220.70 253.81 62120 1,668.20 1,584.79 1,822.51 # 62310 93.31 88.64 101.94 62121 1,524.90 1,448.66 1,665.96 62311 214.51 203.78 234.35 62140 949.08 901.63 1,036.87 # 62311 78.45 74.53 85.71 62141 1,039.08 987.13 1,135.20 62318 258.40 245.48 282.30 62142 789.32 749.85 862.33 # 62318 95.38 90.61 104.20 62143 928.87 882.43 1,014.79 62319 230.44 218.92 251.76 62145 1,255.58 1,192.80 1,371.72 # 62319 88.49 84.07 96.68 62146 1,092.35 1,037.73 1,193.39 62350 468.93 445.48 512.30 62147 1,293.76 1,229.07 1,413.43 62351 768.41 729.99 839.49 62148 115.59 109.81 126.28 62355 384.81 365.57 420.41 62160 179.94 170.94 196.58 62360 257.88 244.99 281.74 62161 1,379.14 1,310.18 1,506.71 62361 414.51 393.78 452.85 62162 1,699.41 1,614.44 1,856.61 62362 515.30 489.54 562.97 62163 1,078.00 1,024.10 1,177.72 62365 401.60 381.52 438.75 62164 1,800.42 1,710.40 1,966.96 62367 38.91 36.96 42.50 62165 1,400.26 1,330.25 1,529.79 # 62367 21.64 20.56 23.64 62180 1,426.92 1,355.57 1,558.91 62368 53.65 50.97 58.62 62190 796.19 756.38 869.84 # 62368 34.27 32.56 37.44 62192 867.52 824.14 947.76 63001 1,110.49 1,054.97 1,213.22 62194 336.87 320.03 368.03 63003 1,120.25 1,064.24 1,223.88 62200 1,241.24 1,179.18 1,356.06 63005 1,065.75 1,012.46 1,164.33 62201 1,063.90 1,010.71 1,162.32 63011 998.38 948.46 1,090.73 62220 922.95 876.80 1,008.32 63012 1,088.31 1,033.89 1,188.97 62223 934.26 887.55 1,020.68 63015 1,341.46 1,274.39 1,465.55 62225 449.78 427.29 491.38 63016 1,371.12 1,302.56 1,497.94 62230 752.93 715.28 822.57 63017 1,126.23 1,069.92 1,230.41 62252 99.47 94.50 108.68 63020 1,065.42 1,012.15 1,163.97 62252 TC 55.36 52.59 60.48 63030 888.62 844.19 970.82 62252 26 44.10 41.90 48.19 63035 188.47 179.05 205.91 62256 521.43 495.36 569.66 63040 1,296.56 1,231.73 1,416.49 62258 1,016.32 965.50 1,110.33 63042 1,218.41 1,157.49 1,331.11 62263 695.34 660.57 759.66 63043 385.52 366.24 421.18 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 52 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 63044 350.57 333.04 383.00 63285 2,357.13 2,239.27 2,575.16 63045 1,157.35 1,099.48 1,264.40 63286 2,356.05 2,238.25 2,573.99 63046 1,105.90 1,050.61 1,208.20 63287 2,474.20 2,350.49 2,703.06 63047 1,016.29 965.48 1,110.30 63290 2,484.67 2,360.44 2,714.51 63048 201.71 191.62 220.36 63295 294.42 279.70 321.66 63050 1,377.38 1,308.51 1,504.79 63300 1,672.32 1,588.70 1,827.01 63051 1,556.59 1,478.76 1,700.57 63301 1,850.21 1,757.70 2,021.36 63055 1,488.61 1,414.18 1,626.31 63302 1,837.69 1,745.81 2,007.68 63056 1,381.41 1,312.34 1,509.19 63303 1,941.63 1,844.55 2,121.23 63057 311.07 295.52 339.85 63304 2,065.30 1,962.04 2,256.35 63064 1,634.29 1,552.58 1,785.47 63305 2,128.65 2,022.22 2,325.55 63066 190.99 181.44 208.66 63306 2,171.15 2,062.59 2,371.98 63075 1,283.08 1,218.93 1,401.77 63307 1,975.93 1,877.13 2,158.70 63076 240.72 228.68 262.98 63308 311.52 295.94 340.33 63077 1,390.78 1,321.24 1,519.43 63600 751.81 714.22 821.35 63078 190.86 181.32 208.52 63610 1,871.77 1,778.18 2,044.91 63081 1,629.75 1,548.26 1,780.50 # 63610 399.11 379.15 436.02 63082 259.57 246.59 283.58 63615 1,041.77 989.68 1,138.13 63085 1,736.87 1,650.03 1,897.53 63650 400.18 380.17 437.20 63086 183.59 174.41 200.57 63655 765.18 726.92 835.96 63087 2,209.81 2,099.32 2,414.22 63660 403.70 383.52 441.05 63088 249.52 237.04 272.60 63685 461.55 438.47 504.24 63090 1,807.01 1,716.66 1,974.16 63688 381.76 362.67 417.07 63091 171.55 162.97 187.42 63700 1,117.42 1,061.55 1,220.78 63101 2,081.75 1,977.66 2,274.31 63702 1,217.00 1,156.15 1,329.57 63102 2,077.54 1,973.66 2,269.71 63704 1,405.95 1,335.65 1,536.00 63103 272.61 258.98 297.83 63706 1,624.08 1,542.88 1,774.31 63170 1,361.25 1,293.19 1,487.17 63707 825.88 784.59 902.28 63172 1,255.96 1,193.16 1,372.13 63709 1,004.34 954.12 1,097.24 63173 1,543.02 1,465.87 1,685.75 63710 1,002.24 952.13 1,094.95 63180 1,269.63 1,206.15 1,387.07 63740 839.39 797.42 917.03 63182 1,307.84 1,242.45 1,428.82 63741 558.17 530.26 609.80 63185 1,013.62 962.94 1,107.38 63744 588.21 558.80 642.62 63190 1,146.78 1,089.44 1,252.86 63746 489.80 465.31 535.11 63191 1,132.48 1,075.86 1,237.24 64400 109.61 104.13 119.75 63194 1,322.90 1,256.76 1,445.27 # 64400 58.22 55.31 63.61 63195 1,361.22 1,293.16 1,487.13 64402 108.49 103.07 118.53 63196 1,594.87 1,515.13 1,742.40 # 64402 68.05 64.65 74.35 63197 1,384.64 1,315.41 1,512.72 64405 102.07 96.97 111.52 63198 1,563.84 1,485.65 1,708.50 # 64405 67.11 63.75 73.31 63199 1,611.99 1,531.39 1,761.10 64408 114.16 108.45 124.72 63200 1,361.72 1,293.63 1,487.67 # 64408 83.41 79.24 91.13 63250 2,608.14 2,477.73 2,849.39 64410 144.12 136.91 157.45 63251 2,745.31 2,608.04 2,999.25 # 64410 72.51 68.88 79.21 63252 2,730.34 2,593.82 2,982.89 64412 142.96 135.81 156.18 63265 1,505.98 1,430.68 1,645.28 # 64412 63.77 60.58 69.67 63266 1,551.06 1,473.51 1,694.54 64413 116.13 110.32 126.87 63267 1,251.26 1,188.70 1,367.01 # 64413 70.21 66.70 76.71 63268 1,238.22 1,176.31 1,352.76 64415 141.44 134.37 154.53 63270 1,856.34 1,763.52 2,028.05 # 64415 68.56 65.13 74.90 63271 1,864.26 1,771.05 2,036.71 64416 165.85 157.56 181.19 63272 1,720.54 1,634.51 1,879.69 64417 145.94 138.64 159.44 63273 1,661.04 1,577.99 1,814.69 # 64417 68.86 65.42 75.23 63275 1,623.17 1,542.01 1,773.31 64418 141.79 134.70 154.91 63276 1,611.58 1,531.00 1,760.65 # 64418 66.81 63.47 72.99 63277 1,421.47 1,350.40 1,552.96 64420 174.56 165.83 190.70 63278 1,391.44 1,321.87 1,520.15 # 64420 60.40 57.38 65.99 63280 1,914.62 1,818.89 2,091.72 64421 263.10 249.95 287.44 63281 1,898.28 1,803.37 2,073.88 # 64421 81.97 77.87 89.55 63282 1,788.05 1,698.65 1,953.45 64425 124.88 118.64 136.44 63283 1,704.83 1,619.59 1,862.53 # 64425 85.29 81.03 93.18 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 53 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 64430 155.68 147.90 170.09 64595 419.45 398.48 458.25 # 64430 80.28 76.27 87.71 # 64595 151.11 143.55 165.08 64435 149.09 141.64 162.89 64600 438.47 416.55 479.03 # 64435 80.01 76.01 87.41 # 64600 196.25 186.44 214.41 64445 143.42 136.25 156.69 64605 566.95 538.60 619.39 # 64445 73.92 70.22 80.75 # 64605 307.47 292.10 335.92 64446 159.13 151.17 173.85 64610 669.33 635.86 731.24 64447 65.96 62.66 72.06 # 64610 439.75 417.76 480.42 64448 144.20 136.99 157.54 64612 155.54 147.76 169.92 64449 142.87 135.73 156.09 # 64612 126.06 119.76 137.72 64450 99.93 94.93 109.17 64613 160.60 152.57 175.46 # 64450 67.07 63.72 73.28 # 64613 119.74 113.75 130.81 64470 298.76 283.82 326.39 64614 179.34 170.37 195.93 # 64470 95.30 90.54 104.12 # 64614 132.59 125.96 144.85 64472 121.10 115.05 132.31 64620 278.73 264.79 304.51 # 64472 60.02 57.02 65.57 # 64620 154.04 146.34 168.29 64475 272.13 258.52 297.30 64622 356.37 338.55 389.33 # 64475 75.83 72.04 82.85 # 64622 162.60 154.47 177.64 64476 102.90 97.76 112.42 64623 132.89 126.25 145.19 # 64476 44.77 42.53 48.91 # 64623 44.43 42.21 48.54 64479 314.74 299.00 343.85 64626 398.56 378.63 435.42 # 64479 113.81 108.12 124.34 # 64626 215.74 204.95 235.69 64480 147.83 140.44 161.51 64627 186.55 177.22 203.80 # 64480 73.27 69.61 80.05 # 64627 52.17 49.56 56.99 64483 314.20 298.49 343.26 64630 224.46 213.24 245.23 # 64483 100.63 95.60 109.94 # 64630 176.86 168.02 193.22 64484 150.48 142.96 164.40 64640 241.67 229.59 264.03 # 64484 62.02 58.92 67.76 # 64640 171.32 162.75 187.16 64505 98.73 93.79 107.86 64650 58.86 55.92 64.31 # 64505 78.51 74.58 85.77 # 64650 35.27 33.51 38.54 64508 152.96 145.31 167.11 64653 66.89 63.55 73.08 # 64508 67.45 64.08 73.69 # 64653 44.15 41.94 48.23 64510 156.03 148.23 170.46 64680 325.22 308.96 355.30 # 64510 62.93 59.78 68.75 # 64680 149.56 142.08 163.39 64517 171.22 162.66 187.06 64681 433.51 411.83 473.60 # 64517 110.56 105.03 120.78 # 64681 206.46 196.14 225.56 64520 210.64 200.11 230.13 64702 415.07 394.32 453.47 # 64520 70.36 66.84 76.87 64704 313.01 297.36 341.96 64530 208.80 198.36 228.11 64708 429.78 408.29 469.53 # 64530 83.69 79.51 91.44 64712 494.82 470.08 540.59 64550 16.55 15.72 18.08 64713 687.15 652.79 750.71 # 64550 8.54 8.11 9.33 64714 568.85 540.41 621.47 64553 199.44 189.47 217.89 64716 491.49 466.92 536.96 # 64553 153.53 145.85 167.73 64718 526.99 500.64 575.74 64555 207.01 196.66 226.16 64719 370.78 352.24 405.08 # 64555 139.62 132.64 152.54 64721 397.57 377.69 434.34 64560 193.29 183.63 211.17 # 64721 396.31 376.49 432.96 # 64560 140.63 133.60 153.64 64722 301.54 286.46 329.43 64561 1,300.60 1,235.57 1,420.91 64726 276.43 262.61 302.00 # 64561 391.98 372.38 428.24 64727 175.54 166.76 191.77 64565 185.43 176.16 202.58 64732 342.80 325.66 374.51 # 64565 118.03 112.13 128.95 64734 389.38 369.91 425.40 64573 542.81 515.67 593.02 64736 351.97 334.37 384.53 64575 265.78 252.49 290.36 64738 438.74 416.80 479.32 64577 357.80 339.91 390.90 64740 440.14 418.13 480.85 64580 282.63 268.50 308.78 64742 438.84 416.90 479.44 64581 761.68 723.60 832.14 64744 390.09 370.59 426.18 64585 438.45 416.53 479.01 64746 418.89 397.95 457.64 # 64585 169.28 160.82 184.94 64752 454.26 431.55 496.28 64590 372.57 353.94 407.03 64755 795.29 755.53 868.86 # 64590 187.22 177.86 204.54 64760 429.90 408.41 469.67 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 54 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 64761 415.35 394.58 453.77 64911 761.16 723.10 831.57 64763 471.82 448.23 515.46 65091 568.07 539.67 620.62 64766 557.24 529.38 608.79 65093 571.03 542.48 623.85 64771 543.54 516.36 593.81 65101 652.54 619.91 712.90 64772 515.00 489.25 562.64 65103 679.13 645.17 741.95 64774 380.26 361.25 415.44 65105 745.36 708.09 814.30 64776 365.04 346.79 398.81 65110 1,073.78 1,020.09 1,173.10 64778 175.74 166.95 191.99 65112 1,273.08 1,209.43 1,390.84 64782 422.48 401.36 461.56 65114 1,313.15 1,247.49 1,434.61 64783 208.10 197.70 227.36 65125 439.97 417.97 480.67 64784 669.56 636.08 731.49 # 65125 255.47 242.70 279.11 64786 1,007.87 957.48 1,101.10 65130 642.86 610.72 702.33 64787 241.56 229.48 263.90 65135 653.93 621.23 714.41 64788 354.01 336.31 386.76 65140 708.40 672.98 773.93 64790 766.15 727.84 837.02 65150 523.27 497.11 571.68 64792 966.07 917.77 1,055.44 65155 753.94 716.24 823.68 64795 179.99 170.99 196.64 65175 580.11 551.10 633.77 64802 566.59 538.26 619.00 65205 50.34 47.82 54.99 64804 874.32 830.60 955.19 # 65205 37.70 35.82 41.19 64809 808.17 767.76 882.92 65210 61.60 58.52 67.30 64818 621.76 590.67 679.27 # 65210 45.59 43.31 49.81 64820 700.17 665.16 764.93 65220 51.78 49.19 56.57 64821 639.79 607.80 698.97 # 65220 37.46 35.59 40.93 64822 636.96 605.11 695.88 65222 67.61 64.23 73.86 64823 719.31 683.34 785.84 # 65222 49.50 47.03 54.08 64831 676.38 642.56 738.94 65235 592.32 562.70 647.11 64832 326.84 310.50 357.08 65260 819.61 778.63 895.42 64834 693.02 658.37 757.13 65265 919.28 873.32 1,004.32 64835 751.25 713.69 820.74 65270 257.92 245.02 281.77 64836 752.40 714.78 822.00 # 65270 121.86 115.77 133.14 64837 362.18 344.07 395.68 65272 452.06 429.46 493.88 64840 841.72 799.63 919.57 # 65272 292.83 278.19 319.92 64856 940.96 893.91 1,028.00 65273 322.67 306.54 352.52 64857 984.13 934.92 1,075.16 65275 481.09 457.04 525.60 64858 1,126.07 1,069.77 1,230.24 # 65275 380.41 361.39 415.60 64859 246.51 234.18 269.31 65280 564.94 536.69 617.19 64861 1,281.67 1,217.59 1,400.23 65285 877.35 833.48 958.50 64862 1,301.36 1,236.29 1,421.73 65286 643.81 611.62 703.36 64864 829.32 787.85 906.03 # 65286 415.50 394.73 453.94 64865 1,111.65 1,056.07 1,214.48 65290 417.04 396.19 455.62 64866 1,137.02 1,080.17 1,242.20 65400 586.39 557.07 640.63 64868 989.55 940.07 1,081.08 # 65400 506.36 481.04 553.20 64870 965.43 917.16 1,054.73 65410 131.19 124.63 143.32 64872 114.99 109.24 125.63 # 65410 89.91 85.41 98.22 64874 171.63 163.05 187.51 65420 480.45 456.43 524.89 64876 194.98 185.23 213.01 # 65420 326.28 309.97 356.47 64885 1,072.92 1,019.27 1,172.16 65426 592.29 562.68 647.08 64886 1,266.41 1,203.09 1,383.55 # 65426 406.10 385.80 443.67 64890 1,012.94 962.29 1,106.63 65430 101.70 96.62 111.11 64891 993.41 943.74 1,085.30 # 65430 90.33 85.81 98.68 64892 980.82 931.78 1,071.55 65435 71.44 67.87 78.05 64893 1,054.58 1,001.85 1,152.13 # 65435 60.91 57.86 66.54 64895 1,197.55 1,137.67 1,308.32 65436 330.97 314.42 361.58 64896 1,309.06 1,243.61 1,430.15 # 65436 315.39 299.62 344.56 64897 1,173.05 1,114.40 1,281.56 65450 280.96 266.91 306.95 64898 1,276.26 1,212.45 1,394.32 # 65450 276.75 262.91 302.35 64901 572.93 544.28 625.92 65600 341.23 324.17 372.80 64902 669.02 635.57 730.91 # 65600 284.36 270.14 310.66 64905 892.60 847.97 975.17 65710 943.72 896.53 1,031.01 64907 1,164.63 1,106.40 1,272.36 65730 1,045.01 992.76 1,141.67 64910 627.00 595.65 685.00 65750 1,058.49 1,005.57 1,156.41 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 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 55 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 65755 1,052.25 999.64 1,149.59 # 66720 362.35 344.23 395.86 65770 1,205.15 1,144.89 1,316.62 66740 380.57 361.54 415.77 65772 392.52 372.89 428.82 # 66740 337.60 320.72 368.83 # 65772 343.24 326.08 374.99 66761 394.21 374.50 430.68 65775 472.99 449.34 516.74 # 66761 349.56 332.08 381.89 65780 770.09 731.59 841.33 66762 410.72 390.18 448.71 65781 1,147.75 1,090.36 1,253.91 # 66762 360.17 342.16 393.48 65782 992.37 942.75 1,084.16 66770 454.66 431.93 496.72 65800 134.53 127.80 146.97 # 66770 407.48 387.11 445.18 # 65800 113.47 107.80 123.97 66820 358.29 340.38 391.44 65805 148.85 141.41 162.62 66821 282.10 268.00 308.20 # 65805 113.89 108.20 124.43 # 66821 263.57 250.39 287.95 65810 395.72 375.93 432.32 66825 664.68 631.45 726.17 65815 582.45 553.33 636.33 66830 604.30 574.09 660.20 # 65815 402.58 382.45 439.82 66840 592.24 562.63 647.02 65820 655.33 622.56 715.94 66850 671.74 638.15 733.87 65850 727.23 690.87 794.50 66852 718.51 682.58 784.97 65855 301.53 286.45 329.42 66920 642.01 609.91 701.40 # 65855 257.72 244.83 281.55 66930 727.56 691.18 794.86 65860 279.20 265.24 305.03 66940 662.89 629.75 724.21 # 65860 221.91 210.81 242.43 66982 916.17 870.36 1,000.91 65865 416.75 395.91 455.30 66983 614.42 583.70 671.26 65870 508.11 482.70 555.11 66984 653.40 620.73 713.84 65875 538.68 511.75 588.51 66985 646.57 614.24 706.38 65880 567.22 538.86 619.69 66986 795.31 755.54 868.87 65900 833.96 792.26 911.10 66990 78.80 74.86 86.09 65920 670.77 637.23 732.81 67005 402.06 381.96 439.25 65930 554.92 527.17 606.25 67010 464.00 440.80 506.92 66020 173.54 164.86 189.59 67015 502.56 477.43 549.04 # 66020 114.15 108.44 124.71 67025 637.26 605.40 696.21 66030 155.54 147.76 169.92 # 67025 533.21 506.55 582.53 # 66030 95.72 90.93 104.57 67027 725.92 689.62 793.06 66130 633.97 602.27 692.61 67028 191.10 181.55 208.78 # 66130 493.69 469.01 539.36 # 67028 145.61 138.33 159.08 66150 741.19 704.13 809.75 67030 448.00 425.60 489.44 66155 738.43 701.51 806.74 67031 335.15 318.39 366.15 66160 835.62 793.84 912.92 # 67031 300.60 285.57 328.41 66165 725.59 689.31 792.71 67036 821.45 780.38 897.44 66170 1,010.92 960.37 1,104.43 67039 1,056.63 1,003.80 1,154.37 66172 1,267.40 1,204.03 1,384.63 67040 1,215.68 1,154.90 1,328.14 66180 993.38 943.71 1,085.27 67041 1,104.26 1,049.05 1,206.41 66185 631.36 599.79 689.76 67042 1,261.49 1,198.42 1,378.18 66220 615.71 584.92 672.66 67043 1,326.15 1,259.84 1,448.82 66225 789.65 750.17 862.70 67101 672.54 638.91 734.75 66250 683.61 649.43 746.84 # 67101 568.92 540.47 621.54 # 66250 468.77 445.33 512.13 67105 619.45 588.48 676.75 66500 312.68 297.05 341.61 # 67105 544.47 517.25 594.84 66505 341.48 324.41 373.07 67107 1,030.38 978.86 1,125.69 66600 694.05 659.35 758.25 67108 1,366.23 1,297.92 1,492.61 66605 905.89 860.60 989.69 67110 755.02 717.27 824.86 66625 371.36 352.79 405.71 # 67110 653.92 621.22 714.40 66630 481.95 457.85 526.53 67112 1,125.39 1,069.12 1,229.49 66635 486.28 461.97 531.27 67113 1,457.63 1,384.75 1,592.46 66680 436.44 414.62 476.81 67115 418.32 397.40 457.01 66682 531.47 504.90 580.64 67120 578.00 549.10 631.47 66700 389.29 369.83 425.30 # 67120 470.16 446.65 513.65 # 66700 336.64 319.81 367.78 67121 768.39 729.97 839.47 66710 383.52 364.34 418.99 67141 447.46 425.09 488.85 # 66710 334.65 317.92 365.61 # 67141 410.81 390.27 448.81 66711 537.78 510.89 587.52 67145 449.30 426.84 490.87 66720 407.00 386.65 444.65 # 67145 419.39 398.42 458.18 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