Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 82270 BLOOD $4.49 20060701 99999999 82271 BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; OTHER SOURCES $4.54 20060701 99999999 82272 BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE, FECES, SINGLE S $4.54 20060701 99999999 82273 BLOOD $4.49 19990701 99999999 82274 BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE, FE $13.33 20060701 99999999 82286 BRADYKININ $5.77 20060701 99999999 82300 CADMIUM, URINE $19.40 20060701 99999999 82306 CALCIFEDIOL (25-OH VITAMIN D-3), CHROMATOGRAPHIC TECHNIQUE $40.91 20060701 99999999 82307 CALCIFEROL (VITAMIN D), RIA $27.01 20060701 99999999 82308 CALCITONIN, RIA $37.01 20060701 99999999 82310 CALCIUM, BLOOD $7.12 20060701 99999999 82330 CALCIUM, BLOOD $18.88 20060701 99999999 82331 CALCIUM, BLOOD $4.34 20060701 99999999 82340 CALCIUM, URINE $8.34 20060701 99999999 82355 CALCULUS (STONE), QUALITATIVE, CHEMICAL $15.99 20060701 99999999 82360 CALCULUS (STONE), QUANTITATIVE $17.80 20060701 99999999 82365 CALCULUS (STONE), QUANTITATIVE $11.44 20060701 99999999 82370 CALCULUS (STONE), QUANTITATIVE $17.32 20060701 99999999 82373 CARBOHYDRATE DEFICIENT TRANSFERRIN $25.23 20060701 99999999 82374 CARBON DIOXIDE, COMBINING POWER OR CONTENT $6.76 20060701 99999999 82375 CARBON MONOXIDE, (CARBOXYHEMOGLOBIN) $17.03 20060701 99999999 82376 CARBON MONOXIDE, (CARBOXYHEMOGLOBIN) $5.02 20060701 99999999 82378 CARCINOEMBRYONIC ANTIGEN (CEA) $26.22 20060701 99999999 82379 CARNITINE (TOTAL AND FREE), QUANTITATIVE, EACH SPECIMEN $23.31 20060701 99999999 82380 CAROTENE, BLOOD $12.75 20060701 99999999 82382 CATECHOLAMINES (DOPAMINE, NOREPINEPHRINE, EPINEPHRINE) $14.41 20060701 99999999 82383 CATECHOLAMINES (DOPAMINE, NOREPINEPHRINE, EPINEPHRINE) $21.01 20060701 99999999 82384 CATECHOLAMINES (DOPAMINE, NOREPINEPHRINE, EPINEPHRINE) $34.90 20060701 99999999 82387 CATHEPSIN-D $17.44 20060701 99999999 82390 CERULOPLASMIN, CHEMICAL (COPPER OXIDASE), BLOOD $14.84 20060701 99999999 82397 CHEMILUMINESCENT ASSAY $11.84 20060701 99999999 82415 CHLORAMPHENICOL, BLOOD $10.62 20060701 99999999 82435 CHLORIDES $6.35 20060701 99999999 82436 CHLORIDES $6.95 20060701 99999999 82438 CHLORIDES $6.76 20060701 99999999 82441 CHLORINATED HYDROCARBONS, SCREEN $5.03 20060701 99999999 82465 CHOLESTEROL, SERUM $6.02 20060701 99999999 82480 CHOLINESTERASE $10.89 20060701 99999999 82482 CHOLINESTERASE $6.44 20060701 99999999 82485 CHONDROITIN B SULFATE, QUANTITATIVE $17.31 20060701 99999999 82486 CHROMATOGRAPHY $15.14 20060701 99999999 82487 CHROMATOGRAPHY $13.38 20060701 99999999 82488 CHROMATOGRAPHY $17.91 20060701 99999999 82489 CHROMATOGRAPHY $15.50 20060701 99999999 82491 CHROMOTOGRAPHY, QUANTITATIVE; COLUMN (EG, GAS LIQUID OR HIGH PERFORMANCE LIQUID $24.96 20060701 99999999 82492 CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID OR HPLC); MULTIPLE ANALYTES $24.96 20060701 99999999 82495 CHROMIUM, URINE $28.03 20060701 99999999 82507 CITRATE $38.43 20060701 99999999 82520 COCAINE, QUANTITATIVE $20.94 20060701 99999999 82523 COLLAGEN CROSS LINKS, ANY METHOD $25.83 20060701 99999999 82525 COPPER $17.15 20060701 99999999 82528 CORTICOSTERONE, RIA $18.87 20060701 99999999 82530 CORTISOL; FREE $23.10 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 246
PROC-CODE DESC MAC BEG END 82533 CORTISOL $22.53 20060701 99999999 82540 CREATINE $6.40 20060701 99999999 82541 COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/MS), ANALYTE NOT ELS $24.96 20060701 99999999 82542 COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/MS), ANALYTE NOT ELS $24.96 20060701 99999999 82543 COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/MS), ANALYTE NOT ELS $15.14 20060701 99999999 82544 COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/MS), ANALYTE NOT ELS $15.14 20060701 99999999 82550 CREATINE PHOSPHOKINASE (CPK), BLOOD $9.01 20060701 99999999 82552 CREATINE PHOSPHOKINASE (CPK), BLOOD $18.51 20060701 99999999 82553 CREATINE KINASE (CK), (CPK); MB FRACTION ONLY $15.95 20060701 99999999 82554 CREATINE KINASE (CK), (CPK); ISOFORMS $9.95 20060701 99999999 82565 CREATININE $7.07 20060701 99999999 82570 CREATININE $7.15 20060701 99999999 82575 CREATININE $13.06 20060701 99999999 82585 CRYOFIBRINOGEN, BLOOD $11.85 20060701 99999999 82595 CRYOGLOBULIN, BLOOD $8.95 20060701 99999999 82600 CYANIDE $16.27 20060701 99999999 82607 CYANOCOBALAMIN (VITAMIN B-12) $20.83 20060701 99999999 82608 CYANOCOBALAMIN (VITAMIN B-12) $19.80 20060701 99999999 82610 CYSTATIN C $19.00 20080101 99999999 82615 CYSTINE AND HOMOCYSTINE, URINE $11.29 20060701 99999999 82626 DEHYDROEPIANDROSTERONE (DHEA), RIA $34.93 20060701 99999999 82627 DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S) $30.72 20060701 99999999 82633 DESOXYCORTICOSTERONE, 11-, RIA $25.97 20060701 99999999 82634 DEOXYCORTISOL, 11-(COMPOUND S), RIA $24.54 20060701 99999999 82638 DIBUCAINE NUMBER $10.27 20060701 99999999 82646 DIHYDROCODEINONE $17.31 20060701 99999999 82649 DIHYDROMORPHINONE, QUANTITATIVE $21.55 20060701 99999999 82651 DIHYDROTESTOSTERONE (DHT) $35.68 20060701 99999999 82652 DIHYDROXYVITAMIN D, 1,25- $53.19 20060701 99999999 82654 DIMETHADIONE $11.60 20060701 99999999 82656 DOXEPIN $15.95 20060701 99999999 82657 ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, OR TISSUE, NOT ELSEWHERE SPECIFI $24.96 20060701 99999999 82658 ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, OR TISSUE, NOT ELSEWHERE SPECIFI $15.14 20060701 99999999 82664 ELECTROPHORETIC TECHNIQUE, NOT ELSEWHERE SPECIFIED $47.48 20060701 99999999 82666 EPIANDROSTERONE $18.01 20060701 99999999 82668 ERYTHROPOIETIN, BIOASSAY $25.97 20060701 99999999 82670 ESTRADIOL, RIA (PLACENTAL) $38.62 20060701 99999999 82671 ESTROGENS $27.08 20060701 99999999 82672 ESTROGENS $29.97 20060701 99999999 82677 ESTRIOL $33.43 20060701 99999999 82679 ESTRONE $20.93 20060701 99999999 82690 ETHCHLORVYNOL $14.49 20060701 99999999 82693 ETHYLENE GLYCOL $20.59 20060701 99999999 82696 ETIOCHOLANOLONE, RIA $19.77 20060701 99999999 82705 FAT OR LIPIDS, FECES $7.04 20060701 99999999 82710 FAT OR LIPIDS, FECES $23.21 20060701 99999999 82715 FAT DIFFERENTIAL, FECES, QUANTITATIVE $23.79 20060701 99999999 82725 FATTY ACIDS, BLOOD $18.40 20060701 99999999 82726 VERY LONG CHAIN FATTY ACIDS $25.23 20060701 99999999 82728 FERRITIN, SPECIFY METHOD (EG, RIA, IMMUNORADIOMETRIC ASSAY) $15.81 20060701 99999999 82731 FETAL FIBRONECTIN, CERVICOVAGINAL SECRETIONS, SEMI- QUANTITATIVE $89.01 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 247
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