Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 70110 RADIOLOGIC EXAMINATION, MANDIBLE $34.71 20060701 99999999 70120 RADIOLOGIC EXAMINATION, MASTOIDS $34.15 20060701 99999999 70130 RADIOLOGIC EXAMINATION, MASTOIDS $39.20 20060701 99999999 70134 RADIOLOGIC EXAMINATION, INTERNAL AUDITORY MEATI, COMPLETE $37.65 20060701 99999999 70140 RADIOLOGIC EXAMINATION, FACIAL BONES $31.49 20060701 99999999 70150 RADIOLOGIC EXAMINATION, FACIAL BONES $40.82 20060701 99999999 70160 RADIOLOGIC EXAMINATION, NASAL BONES, COMPLETE, MINIMUM OF $27.12 20060701 99999999 70170 DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT $43.39 20060701 99999999 70190 RADIOLOGIC EXAMINATION $28.99 20060701 99999999 70200 RADIOLOGIC EXAMINATION $41.79 20060701 99999999 70210 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN THREE $30.52 20060701 99999999 70220 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE, MINIMUM $40.07 20060701 99999999 70240 RADIOLOGIC EXAMINATION, SELLA TURCICA $21.66 20060701 99999999 70250 RADIOLOGIC EXAMINATION, SKULL $30.09 20060701 99999999 70260 RADIOLOGIC EXAMINATION, SKULL $48.43 20060701 99999999 70300 RADIOLOGIC EXAMINATION, TEETH $13.36 20060701 99999999 70310 RADIOLOGIC EXAMINATION, TEETH $20.56 20060701 99999999 70320 RADIOLOGIC EXAMINATION, TEETH $34.80 20060701 99999999 70328 RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND $23.89 20060701 99999999 70330 RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND $40.04 20060701 99999999 70332 TEMPOROMANDIBULAR JOINT ARTHROGRAPHY $90.82 20060701 99999999 70336 MAGNETIC RENONANCE(EG,PROTON)IMAGING,TEMPOROMANDIBULAR JOINT $423.20 20060701 99999999 70350 CEPHALOGRAM, ORTHODONTIC $19.57 20060701 99999999 70355 ORTHOPANTOGRAM $26.85 20060701 99999999 70360 RADIOLOGIC EXAMINATION $20.82 20060701 99999999 70370 RADIOLOGIC EXAMINATION $44.39 20060701 99999999 70371 COMPLEX DYNAMIC PHARY. & SPEECH EVAL. BY CINE OR VIDEO REC. $82.48 20060701 99999999 70373 LARYNGOGRAPHY, CONTRAST $61.18 20060701 99999999 70380 RADIOLOGIC EXAMINATION, SALIVARY GLAND FOR CALCULUS $23.24 20060701 99999999 70390 SIALOGRAPHY $73.89 20060701 99999999 70450 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN $203.07 20060701 99999999 70460 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN $256.62 20060701 99999999 70470 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN $310.02 20060701 99999999 70480 COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR $231.00 20060701 99999999 70481 COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR $240.26 20060701 99999999 70482 COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR $289.71 20060701 99999999 70486 COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA $209.20 20060701 99999999 70487 COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA $237.23 20060701 99999999 70488 COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA $288.60 20060701 99999999 70490 COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK $205.75 20060701 99999999 70491 COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK $268.85 20060701 99999999 70492 COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK $289.49 20060701 99999999 70496 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEAD, WITHOUT CONTRAST MATERIAL(S), FOLLOWED B $334.94 20060701 99999999 70498 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, NECK, WITHOUT CONTRAST MATERIAL(S), FOLLOWED B $334.94 20060701 99999999 70540 MAGNETIC RESONANCE (EG, PROTON) IMAGING $427.26 20060701 99999999 70541 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD AND/OR NECK, WITH OR WITHOUT CONTRAST MATER $437.44 19990701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 226
PROC-CODE DESC MAC BEG END 70542 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK; WITH CONTRAST MA $442.17 20060701 99999999 70543 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK; WITHOUT CONTRAST $787.12 20060701 99999999 70544 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S) $366.93 20060701 99999999 70545 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITH CONTRAST MATERIAL(S) $366.93 20060701 99999999 70546 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY $701.32 20060701 99999999 70547 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S) $366.93 20060701 99999999 70548 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITH CONTRAST MATERIAL(S) $366.93 20060701 99999999 70549 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY $701.32 20060701 99999999 70551 MAGNETIC RESONANCE (EG, PROTON) IMAGING, $427.26 20060701 99999999 70552 MRI BRAIN, INCL BRAIN STEM; WITH CONTRAST $512.45 20060701 99999999 70553 MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT C $912.41 20060701 99999999 70554 MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MRI; INCLUDING TEST SELECTION AND $444.48 20070101 99999999 71010 RADIOLOGIC EXAMINATION, CHEST $22.95 20060701 99999999 71015 RADIOLOGIC EXAMINATION, CHEST $25.62 20060701 99999999 71020 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL $29.95 20060701 99999999 71021 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL $39.42 20060701 99999999 71022 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL $41.36 20060701 99999999 71023 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL $40.88 20060701 99999999 71030 RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR $38.10 20060701 99999999 71034 RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR $66.13 20060701 99999999 71035 RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS, EG, LATERAL $24.20 20060701 99999999 71036 NEEDLE BIOPSY OF INTRATHORACIC LESION, INCLUDING FOLLOW-UP FILMS $82.50 19990701 99999999 71040 BRONCHOGRAPHY, UNILATERAL $71.16 20060701 99999999 71060 BRONCHOGRAPHY, BILATERAL $102.20 20060701 99999999 71090 INSERTION PACEMAKER, FLUOROSCOPY AND RADIOGRAPHY, SUPERVISION $78.41 20060701 99999999 71100 RADIOLOGIC EXAMINATION, RIBS, UNILATERAL $27.69 20060701 99999999 71101 RADIOLOGIC EXAMINATION, RIBS, UNILATERAL $37.39 20060701 99999999 71110 RADIOLOGIC EXAMINATION, RIBS, BILATERAL $38.95 20060701 99999999 71111 RADIOLOGIC EXAMINATION, RIBS, BILATERAL $42.36 20060701 99999999 71120 RADIOLOGIC EXAMINATION $31.55 20060701 99999999 71130 RADIOLOGIC EXAMINATION $32.05 20060701 99999999 71250 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX $266.42 20060701 99999999 71260 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX $304.37 20060701 99999999 71270 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX $381.88 20060701 99999999 71275 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST, WITHOUT CONTRAST MATERIAL(S), FOLLOWED $382.28 20060701 99999999 71550 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR $431.66 20060701 99999999 71551 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND $446.99 20060701 99999999 71552 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND $788.32 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 227
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