CPT code 38221: Bone marrow biopsy, biopsy without aspiration2026 Medicare rate & RVUs in North Carolina
Reports needle or trocar sampling of bone marrow for diagnostic evaluation when a core biopsy is performed without marrow aspiration.
In North Carolina, Medicare pays $157.53 for 38221 in the office and $55.63 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 38221 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 38221 covers
A clinician obtains a core of marrow through a needle or trocar, most often from the posterior iliac crest, to evaluate suspected or known marrow disease. Hematologists and oncologists commonly perform the procedure in an office, clinic, or hospital setting, often using local anesthesia. Typical indications include unexplained cytopenias, suspected leukemia or lymphoma, plasma cell disorders, and assessment of marrow involvement. The specimen is sent for pathologic evaluation.
Report 38221 when a diagnostic core biopsy is performed without aspiration; when both biopsy and aspiration are performed, use 38222 instead. Documentation should identify the indication, biopsy site and side, and the procedure performed. For bilateral biopsies, CMS pays 150% when modifier 50 is reported. When this service and another procedure subject to the multiple-procedure rule are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How North Carolina compares for 38221
Across 109 of 109 payment localities, the office rate for 38221 runs from $148.08 in Arkansas to $223.63 in San Benito County, CA. North Carolina pays $157.53. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Carolina · this page$157.53
- Los Angeles, CA · California$189.73+$32.20
- Washington, DC area · District of Columbia$191.32+$33.79
- Miami, FL · Florida$177.61+$20.08
- Chicago, IL · Illinois$172.66+$15.13
- Manhattan, NY · New York$191.53+$34.00
- Alaska · Alaska$194.13+$36.60
Other areas in North Carolina first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $150.21 | $54.64 |
| ArkansasArkansas | $148.08 | $54.26 |
| ArizonaArizona | $162.71 | $56.87 |
| Bakersfield, CACalifornia | $178.03 | $58.33 |
| Chico, CACalifornia | $177.68 | $57.97 |
| El Centro, CACalifornia | $177.70 | $57.99 |
| Fresno, CACalifornia | $177.68 | $57.97 |
| Hanford, CACalifornia | $177.68 | $57.97 |
| Madera, CACalifornia | $177.68 | $57.97 |
| Merced, CACalifornia | $177.68 | $57.97 |
| Modesto, CACalifornia | $177.68 | $57.97 |
| Napa, CACalifornia | $206.49 | $62.54 |
| Oxnard, CACalifornia | $188.92 | $59.82 |
| Redding, CACalifornia | $177.68 | $57.97 |
| Rest of CaliforniaCalifornia | $177.68 | $57.97 |
| Riverside, CACalifornia | $178.89 | $59.18 |
| Sacramento, CACalifornia | $186.62 | $59.60 |
| Salinas, CACalifornia | $185.93 | $59.34 |
| San Diego, CACalifornia | $190.40 | $59.78 |
| Marin County, CACalifornia | $218.83 | $64.83 |
| San Francisco, CACalifornia | $218.71 | $64.70 |
| San Benito County, CACalifornia | $223.63 | $66.13 |
| Santa Clara County, CACalifornia | $223.12 | $65.62 |
| San Luis Obispo, CACalifornia | $182.91 | $58.51 |
| Santa Cruz, CACalifornia | $192.32 | $59.61 |
| Santa Maria, CACalifornia | $186.65 | $59.30 |
| Santa Rosa, CACalifornia | $194.27 | $60.15 |
| Stockton, CACalifornia | $177.68 | $57.97 |
| Vallejo, CACalifornia | $206.31 | $62.36 |
| Visalia, CACalifornia | $177.68 | $57.97 |
| Yuba City, CACalifornia | $177.68 | $57.97 |
| ColoradoColorado | $174.48 | $58.27 |
| ConnecticutConnecticut | $177.97 | $60.34 |
| DelawareDelaware | $165.38 | $57.47 |
| Fort Lauderdale, FLFlorida | $171.55 | $60.91 |
| Rest of FloridaFlorida | $163.50 | $59.09 |
| Atlanta, GAGeorgia | $169.81 | $58.85 |
| Rest of GeorgiaGeorgia | $154.58 | $57.15 |
| Hawaii, Guam, HIHawaii | $182.11 | $57.93 |
| IowaIowa | $154.45 | $54.52 |
| IdahoIdaho | $155.34 | $54.86 |
| East St. Louis, ILIllinois | $161.00 | $60.52 |
| Rest of IllinoisIllinois | $158.50 | $58.78 |
| Suburban Chicago, ILIllinois | $173.42 | $61.25 |
| IndianaIndiana | $156.24 | $54.99 |
| KansasKansas | $153.51 | $54.77 |
| KentuckyKentucky | $153.20 | $56.10 |
| New Orleans, LALouisiana | $160.33 | $57.55 |
| Rest of LouisianaLouisiana | $152.87 | $56.21 |
| Metropolitan Boston, MAMassachusetts | $191.90 | $61.49 |
| Rest of MassachusettsMassachusetts | $173.37 | $58.36 |
| Baltimore area, MDMaryland | $177.42 | $60.22 |
| Rest of MarylandMaryland | $168.58 | $58.05 |
| Rest of MaineMaine | $155.89 | $55.41 |
| Southern Maine, MEMaine | $164.55 | $56.32 |
| Detroit, MIMichigan | $165.27 | $59.87 |
| Rest of MichiganMichigan | $156.90 | $57.18 |
| MinnesotaMinnesota | $167.94 | $55.56 |
| Metropolitan Kansas City, MOMissouri | $159.50 | $56.95 |
| Metropolitan St. Louis, MOMissouri | $161.18 | $57.20 |
| Rest of MissouriMissouri | $150.13 | $55.98 |
| MississippiMississippi | $149.15 | $55.11 |
| MontanaMontana | $167.00 | $57.78 |
| North DakotaNorth Dakota | $164.82 | $55.60 |
| NebraskaNebraska | $155.36 | $54.55 |
| New HampshireNew Hampshire | $171.53 | $57.83 |
| Northern New JerseyNew Jersey | $189.34 | $62.64 |
| Rest of New JerseyNew Jersey | $180.22 | $60.95 |
| New MexicoNew Mexico | $157.65 | $57.50 |
| NevadaNevada | $166.51 | $57.18 |
| NYC suburbs and Long Island, NYNew York | $195.80 | $65.94 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $181.20 | $61.61 |
| Queens, NYNew York | $193.43 | $64.33 |
| Rest of New YorkNew York | $159.83 | $56.07 |
| OhioOhio | $156.46 | $56.74 |
| OklahomaOklahoma | $153.18 | $55.64 |
| Portland, OROregon | $180.23 | $58.88 |
| Rest of OregonOregon | $165.43 | $56.64 |
| Metropolitan Philadelphia, PAPennsylvania | $173.45 | $59.75 |
| Rest of PennsylvaniaPennsylvania | $156.83 | $56.57 |
| Puerto RicoPuerto Rico | $168.29 | $57.86 |
| Rhode IslandRhode Island | $171.41 | $58.59 |
| South CarolinaSouth Carolina | $157.21 | $56.29 |
| South DakotaSouth Dakota | $164.56 | $55.34 |
| TennesseeTennessee | $154.24 | $54.96 |
| Austin, TXTexas | $173.72 | $58.16 |
| Beaumont, TXTexas | $155.80 | $56.41 |
| Brazoria, TXTexas | $165.44 | $57.20 |
| Dallas, TXTexas | $166.37 | $57.59 |
| Fort Worth, TXTexas | $165.20 | $57.51 |
| Galveston, TXTexas | $165.86 | $57.40 |
| Houston, TXTexas | $167.87 | $59.41 |
| Rest of TexasTexas | $160.45 | $56.80 |
| UtahUtah | $159.33 | $56.67 |
| VirginiaVirginia | $163.86 | $56.49 |
| Virgin Islands, VIUnited States Virgin Islands | $168.29 | $57.86 |
| VermontVermont | $163.97 | $55.84 |
| Rest of WashingtonWashington | $173.11 | $58.10 |
| King County, WAWashington | $196.02 | $62.00 |
| WisconsinWisconsin | $159.36 | $54.72 |
| West VirginiaWest Virginia | $152.66 | $57.75 |
| WyomingWyoming | $166.05 | $56.83 |
38221 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$148.08
$200.66
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $194.13 | 1 |
| AL | $150.21 | 1 |
| AR | $148.08 | 1 |
| AZ | $162.71 | 1 |
| CA | $177.68–$223.63 | 29 |
| CO | $174.48 | 1 |
| CT | $177.97 | 1 |
| DC | $191.32 | 1 |
| DE | $165.38 | 1 |
| FL | $163.50–$177.61 | 3 |
| GA | $154.58–$169.81 | 2 |
| GU | $182.11 | 1 |
| HI | $182.11 | 1 |
| IA | $154.45 | 1 |
| ID | $155.34 | 1 |
| IL | $158.50–$173.42 | 4 |
| IN | $156.24 | 1 |
| KS | $153.51 | 1 |
| KY | $153.20 | 1 |
| LA | $152.87–$160.33 | 2 |
| MA | $173.37–$191.90 | 2 |
| MD | $168.58–$191.32 | 3 |
| ME | $155.89–$164.55 | 2 |
| MI | $156.90–$165.27 | 2 |
| MN | $167.94 | 1 |
| MO | $150.13–$161.18 | 3 |
| MS | $149.15 | 1 |
| MT | $167.00 | 1 |
| NC | $157.53 | 1 |
| ND | $164.82 | 1 |
| NE | $155.36 | 1 |
| NH | $171.53 | 1 |
| NJ | $180.22–$189.34 | 2 |
| NM | $157.65 | 1 |
| NV | $166.51 | 1 |
| NY | $159.83–$195.80 | 5 |
| OH | $156.46 | 1 |
| OK | $153.18 | 1 |
| OR | $165.43–$180.23 | 2 |
| PA | $156.83–$173.45 | 2 |
| PR | $168.29 | 1 |
| RI | $171.41 | 1 |
| SC | $157.21 | 1 |
| SD | $164.56 | 1 |
| TN | $154.24 | 1 |
| TX | $155.80–$173.72 | 8 |
| UT | $159.33 | 1 |
| VA | $163.86–$191.32 | 2 |
| VI | $168.29 | 1 |
| VT | $163.97 | 1 |
| WA | $173.11–$196.02 | 2 |
| WI | $159.36 | 1 |
| WV | $152.66 | 1 |
| WY | $166.05 | 1 |
How the 38221 rate is calculated
Each of 38221’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 38221
RVUs × geographic indexes × conversion factor
Work1.25
1.25 RVUs× 1.000 GPCI
Practice expense3.64
3.64 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
5.0000
Conversion factor
$33.4009
Medicare rate
$167.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact North Carolina inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
4,723
- Code
- 38221
- Physician work
- 1.25
- Practice expense
- 3.64
- Malpractice
- 0.11
GPCI2026.csv
83
- Locality
- North Carolina
- Physician work
- 1.000
- Practice expense
- 0.933
- Malpractice
- 0.639
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.25 | × 1.000 | 1.2500 |
| Practice expense | 3.64 | × 0.933 | 3.3961 |
| Malpractice | 0.11 | × 0.639 | 0.0703 |
| Total RVUs | 4.7164 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Carolina$157.53
Office: (1.25 × 1 + 3.64 × 0.933 + 0.11 × 0.639) × $33.4009 = $157.53
Facility: (1.25 × 1 + 0.37 × 0.933 + 0.11 × 0.639) × $33.4009 = $55.63
Payment rules and modifiers for 38221
The CMS indicators that decide how 38221 is paid alongside other services.
CMS payment indicators · 38221
Bone marrow biopsy, biopsy without aspiration
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
38221 without 50 · national office
$167.00
Bone marrow biopsy, biopsy without aspiration
38221-50 · Bilateral: 150%
$250.50
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
How 38221 has changed in North Carolina
38221 · Office / nonfacility
$157.53
Effective 2026-10-01
The base rate is $10.94 higher than on 2025-10-01, moving from $146.59 to $157.53 (7.5%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$146.59changed to$157.53
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.28 changed to 1.25
- Practice expense RVU 3.44 changed to 3.64
- Malpractice RVU 0.10 changed to 0.11
- Practice expense GPCI 0.926 changed to 0.933
- Malpractice GPCI 0.665 changed to 0.639
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$152.71changed to$146.59
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 3.50 changed to 3.44
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$150.21changed to$152.71
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$153.95changed to$150.21
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 3.44 changed to 3.50
- Practice expense GPCI 0.927 changed to 0.926
- Malpractice GPCI 0.742 changed to 0.665
January 1, 2023
RVU23A
$157.96changed to$153.95
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 3.46 changed to 3.44
- Malpractice RVU 0.09 changed to 0.10
- Practice expense GPCI 0.928 changed to 0.927
- Malpractice GPCI 0.819 changed to 0.742
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$156.36changed to$157.96
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 3.37 changed to 3.46
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$152.70changed to$156.36
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 3.10 changed to 3.37
- Practice expense GPCI 0.930 changed to 0.928
- Malpractice GPCI 0.757 changed to 0.819
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$149.71changed to$152.70
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 3.02 changed to 3.10
- Practice expense GPCI 0.931 changed to 0.930
- Malpractice GPCI 0.695 changed to 0.757
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$148.54changed to$149.71
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.99 changed to 3.02
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$162.13changed to$148.54
- Conversion factor 35.8887 changed to 35.9996
- Work RVU 1.37 changed to 1.28
- Practice expense RVU 3.31 changed to 2.99
- Malpractice GPCI 0.732 changed to 0.695
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$161.41changed to$162.13
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 3.30 changed to 3.31
- Practice expense GPCI 0.930 changed to 0.931
- Malpractice GPCI 0.768 changed to 0.732
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$161.93changed to$161.41
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 3.29 changed to 3.30
- Malpractice RVU 0.10 changed to 0.09
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$161.13changed to$161.93
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$158.67changed to$161.13
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 3.23 changed to 3.29
- Malpractice RVU 0.08 changed to 0.10
- Practice expense GPCI 0.929 changed to 0.930
- Malpractice GPCI 0.732 changed to 0.768
Held through RVU15B.
January 1, 2014
RVU14A
$158.26changed to$158.67
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 3.48 changed to 3.23
- Practice expense GPCI 0.927 changed to 0.929
- Malpractice GPCI 0.695 changed to 0.732
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $158.26
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $157.53 | $55.63 | RVU26D |
| 2026-07-01 | $157.53 | $55.63 | RVU26C |
| 2026-04-01 | $157.53 | $55.63 | RVU26B |
| 2026-01-01 | $157.53 | $55.63 | RVU26A |
| 2025-10-01 | $146.59 | $64.22 | RVU25D |
| 2025-07-01 | $146.59 | $64.22 | RVU25C |
| 2025-04-01 | $146.59 | $64.22 | RVU25B |
| 2025-01-01 | $146.59 | $64.22 | RVU25A |
| 2024-10-01 | $152.71 | $66.40 | RVU24D |
| 2024-07-01 | $152.71 | $66.40 | RVU24C |
| 2024-04-01 | $152.71 | $66.40 | RVU24B |
| 2024-03-09 | $152.71 | $66.40 | RVU24AR |
| 2024-01-01 | $150.21 | $65.31 | RVU24A |
| 2023-10-01 | $153.95 | $67.57 | RVU23D |
| 2023-07-01 | $153.95 | $67.57 | RVU23C |
| 2023-04-01 | $153.95 | $67.57 | RVU23B |
| 2023-01-01 | $153.95 | $67.57 | RVU23A |
| 2022-10-01 | $157.96 | $69.33 | RVU22D |
| 2022-07-01 | $157.96 | $69.33 | RVU22C |
| 2022-04-01 | $157.96 | $69.33 | RVU22B |
| 2022-01-01 | $157.96 | $69.33 | RVU22A |
| 2021-10-01 | $156.36 | $68.61 | RVU21D |
| 2021-07-01 | $156.36 | $68.61 | RVU21C |
| 2021-04-01 | $156.36 | $68.61 | RVU21B |
| 2021-01-01 | $156.36 | $68.61 | RVU21A |
| 2020-10-01 | $152.70 | $69.80 | RVU20D |
| 2020-07-01 | $152.70 | $69.80 | RVU20C |
| 2020-04-01 | $152.70 | $69.80 | RVU20B |
| 2020-01-01 | $152.70 | $69.80 | RVU20A |
| 2019-10-01 | $149.71 | $69.52 | RVU19D |
| 2019-07-01 | $149.71 | $69.52 | RVU19C |
| 2019-04-01 | $149.71 | $69.52 | RVU19B |
| 2019-01-01 | $149.71 | $69.52 | RVU19A |
| 2018-10-01 | $148.54 | $70.12 | RVU18D |
| 2018-07-01 | $148.54 | $70.12 | RVU18C |
| 2018-04-01 | $148.54 | $70.12 | RVU18B |
| 2018-01-01 | $148.54 | $70.12 | RVU18AR1 |
| 2017-10-01 | $162.13 | $74.59 | RVU17D |
| 2017-07-01 | $162.13 | $74.59 | RVU17C |
| 2017-04-01 | $162.13 | $74.59 | RVU17B |
| 2017-01-01 | $162.13 | $74.59 | RVU17A |
| 2016-10-01 | $161.41 | $74.50 | RVU16D |
| 2016-07-01 | $161.41 | $74.50 | RVU16C |
| 2016-04-01 | $161.41 | $74.50 | RVU16B |
| 2016-01-01 | $161.41 | $74.50 | RVU16A |
| 2015-10-01 | $161.93 | $75.05 | RVU15D |
| 2015-07-01 | $161.93 | $75.05 | RVU15C |
| 2015-04-01 | $161.13 | $74.67 | RVU15B |
| 2015-01-01 | $161.13 | $74.67 | RVU15A |
| 2014-10-01 | $158.67 | $74.47 | RVU14D |
| 2014-07-01 | $158.67 | $74.47 | RVU14C |
| 2014-04-01 | $158.67 | $74.47 | RVU14B |
| 2014-01-01 | $158.67 | $74.47 | RVU14A |
| 2013-10-01 | $158.26 | $71.21 | RVU13D |
| 2013-07-01 | $158.26 | $71.21 | RVU13C |
| 2013-04-01 | $158.26 | $71.21 | RVU13B |
| 2013-01-01 | $158.26 | $71.21 | RVU13AR |
Where the North Carolina rate applies
North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Advance
- Ahoskie
- Alamance
- Albemarle
- Alexis
- Alliance
- Altamahaw
38221 billing questions
When should 38221 be chosen over 38222?
Use 38221 for a diagnostic marrow core biopsy without aspiration. When both a biopsy and aspiration are performed, report 38222.
Can marrow aspiration be reported separately with 38221?
When aspiration and biopsy are both performed, use 38222 rather than separately reporting 38220 with 38221.
How is a bilateral bone marrow biopsy reported?
Report modifier 50 for a bilateral procedure; CMS pays 150%. Document the biopsy at both sites.
What documentation supports 38221?
Document the diagnostic indication, the site and side sampled, and that a needle or trocar core biopsy was performed without aspiration.
How does the multiple-procedure reduction affect 38221?
When another procedure subject to the rule is performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 38221 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist