18.04.2015 Views

Medicaid Fee Schedule without Mods 200801

Medicaid Fee Schedule without Mods 200801

Medicaid Fee Schedule without Mods 200801

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

PROC-CODE DESC MAC BEG END<br />

75553<br />

CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY; WITH<br />

CONTRAST MATERIAL $444.25 19990701 99999999<br />

75554<br />

CARDIAC MAGNETIC RESONANCE IMAGING FOR FUNCTION, WITH OR<br />

WITHOUT MORPHOLOGY; COM $440.14 19990701 99999999<br />

75555<br />

CARDIAC MAGNETIC RESONANCE IMAGING FOR FUNCTION, WITH OR<br />

WITHOUT MORPHOLOGY; LIM $438.46 19990701 99999999<br />

75557<br />

CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND<br />

FUNCTION WITHOUT CONTRAST $293.12 <strong>200801</strong>01 99999999<br />

75559<br />

CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND<br />

FUNCTION WITHOUT CONTRAST $313.83 <strong>200801</strong>01 99999999<br />

75561<br />

CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND<br />

FUNCTION WITHOUT CONTRAST $422.83 <strong>200801</strong>01 99999999<br />

75563<br />

CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND<br />

FUNCTION WITHOUT CONTRAST $439.32 <strong>200801</strong>01 99999999<br />

75600 AORTOGRAPHY, THORACIC, WITHOUT SERIALOGRAPHY $435.08 20060701 99999999<br />

75605 AORTOGRAPHY, THORACIC, BY SERIALOGRAPHY $460.17 20060701 99999999<br />

75625 AORTOGRAPHY, ABDOMINAL, TRANSLUMBAR, BY SERIALOGRAPHY $459.80 20060701 99999999<br />

75630<br />

AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER<br />

EXTREMITY, $571.32 20060701 99999999<br />

75635<br />

COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMINAL AORTA AND<br />

BILATERAL ILIOFEMORAL LOWE $487.09 20060701 99999999<br />

75650 ANGIOGRAPHY, CERVICOCEREBRAL, CATHETER, INCLUDING $473.31 20060701 99999999<br />

75658 ANGIOGRAPHY, BRACHIAL, RETROGRADE $467.70 20060701 99999999<br />

75660<br />

ANGIOGRAPHY, EXTERNAL CAROTID, CEREBRAL, UNILATERAL,<br />

SELECTIVE $466.45 20060701 99999999<br />

75662<br />

ANGIOGRAPHY, EXTERNAL CAROTID, CEREBRAL, BILATERAL,<br />

SELECTIVE $479.77 20060701 99999999<br />

75665 ANGIOGRAPHY, CAROTID, CEREBRAL, UNILATERAL $466.70 20060701 99999999<br />

75671 ANGIOGRAPHY, CAROTID, CEREBRAL, BILATERAL $480.22 20060701 99999999<br />

75676 ANGIOGRAPHY, CAROTID, CERVICAL, UNILATERAL $466.70 20060701 99999999<br />

75680 ANGIOGRAPHY, CAROTID, CERVICAL, BILATERAL $480.22 20060701 99999999<br />

75685 ANGIOGRAPHY, VERTEBRAL $466.14 20060701 99999999<br />

75705 ANGIOGRAPHY, SPINAL, SELECTIVE $500.64 20060701 99999999<br />

75710 ANGIOGRAPHY, EXTREMITY, UNILATERAL $550.27 20060701 99999999<br />

75716 ANGIOGRAPHY, EXTREMITY, BILATERAL $466.14 20060701 99999999<br />

75722 ANGIOGRAPHY, RENAL, UNILATERAL, SELECTIVE (INCLUDING FLUSH $460.17 20060701 99999999<br />

75724 ANGIOGRAPHY, RENAL, BILATERAL, SELECTIVE (INCLUDING FLUSH $475.24 20060701 99999999<br />

75726 ANGIOGRAPHY, VISCERAL $459.48 20060701 99999999<br />

75731 ANGIOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE $459.48 20060701 99999999<br />

75733 ANGIOGRAPHY, ADRENAL, BILATERAL, SELECTIVE $466.45 20060701 99999999<br />

75736 ANGIOGRAPHY, PELVIC $459.48 20060701 99999999<br />

75741 ANGIOGRAPHY, PULMONARY, UNILATERAL, SELECTIVE $466.14 20060701 99999999<br />

75743 ANGIOGRAPHY, PULMONARY, BILATERAL, SELECTIVE $479.91 20060701 99999999<br />

75746 ANGIOGRAPHY, PULMONARY $459.23 20060701 99999999<br />

75756 ANGIOGRAPHY, INTERNAL MAMMARY $461.73 20060701 99999999<br />

75774<br />

ANGIOGRAPHY, SELECTIVE, EACH ADDITIONAL VESSEL STUDIED<br />

AFTER $428.91 20060701 99999999<br />

75790 ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS PATIENT) $120.00 20060701 99999999<br />

75801 LYMPHANGIOGRAPHY, EXTREMITY ONLY, UNILATERAL $210.73 20060701 99999999<br />

75803 LYMPHANGIOGRAPHY, EXTREMITY ONLY, BILATERAL $224.19 20060701 99999999<br />

75805 LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, UNILATERAL $233.06 20060701 99999999<br />

75807 LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, BILATERAL $246.78 19990701 99999999<br />

75809<br />

SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED<br />

INDWELLING NONVASCULAR SHUNT ( $44.12 20060701 99999999<br />

75810 SPLENOPORTOGRAPHY $367.45 20060701 99999999<br />

75820 VENOGRAPHY, EXTREMITY, UNILATERAL $59.10 20060701 99999999<br />

Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 232

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!