Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
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PROC-CODE DESC MAC BEG END<br />
84425 THIAMINE (VITAMIN B-1) $26.36 20060701 99999999<br />
84430 THIOCYANATE, BLOOD $9.76 20060701 99999999<br />
84432 THYROGLOBULIN $22.20 20060701 99999999<br />
84436 THYROXINE, TRUE (TT-4), RIA $9.50 20060701 99999999<br />
84437 THYROXINE (T-4) NEONATAL $8.95 20060701 99999999<br />
84439 THYROXINE, FREE (FT-4), RIA (UNBOUND T-4 ONLY) $12.46 20060701 99999999<br />
84442 THYROXINE BINDING GLOBULIN (TBG) $20.44 20060701 99999999<br />
84443 THYROID STIMULATING HORMONE (TSH), RIA OR EIA $23.21 20060701 99999999<br />
84445 THYROTROPIN RELEASING FACTOR (TRF), RIA $32.92 20060701 99999999<br />
84446 TOCOPHEROL ALPHA (VITAMIN E) $19.60 20060701 99999999<br />
84449 TRANSCORTIN (CORTISOL BINDING GLOBULIN) $24.87 20060701 99999999<br />
84450 TRANSAMINASE, GLUTAMIC OXALOACETIC (SGOT), BLOOD $7.14 20060701 99999999<br />
84460 TRANSAMINASE, GLUTAMIC PYRUVIC (SGPT), BLOOD $7.32 20060701 99999999<br />
84466 TRANSFERRIN $17.65 20060701 99999999<br />
84478 TRIGLYCERIDES, BLOOD $7.95 20060701 99999999<br />
84479 TRIIODOTHYRONINE (T-3), RESIN UPTAKE $8.95 20060701 99999999<br />
84480 TRIIODOTHYRONINE TRUE (TT-3), RIA $19.60 20060701 99999999<br />
84481 TRIIODOTHYRONINE, FREE (FT-3), RIA (UNBOUND T-3 ONLY) $23.41 20060701 99999999<br />
84482 TRIDOTHYRONINE (T-3); REVERSE $21.78 20060701 99999999<br />
84484 TROPONIN $13.60 20060701 99999999<br />
84485 TRYPSIN, DUODENAL FLUID $6.29 20060701 99999999<br />
84488 TRYPSIN, FECES $6.12 20060701 99999999<br />
84490 TRYPSIN, FECES $6.38 20060701 99999999<br />
84510 TYROSINE, BLOOD $8.72 20060701 99999999<br />
84512 TROPONIN, QUALITATIVE $10.64 20060701 99999999<br />
84520 UREA NITROGEN, BLOOD (BUN) $5.45 20060701 99999999<br />
84525 UREA NITROGEN, BLOOD (BUN) $4.02 20060701 99999999<br />
84540 UREA NITROGEN, URINE $6.56 20060701 99999999<br />
84545 UREA NITROGEN, CLEARANCE $9.12 20060701 99999999<br />
84550 URIC ACID $6.25 20060701 99999999<br />
84560 URIC ACID, URINE $6.56 20060701 99999999<br />
84565 UROBILIN, URINE $7.73 20010101 99999999<br />
84577 UROBILINOGEN, FECES, QUANTITATIVE $10.46 20060701 99999999<br />
84578 UROBILINOGEN, URINE $2.72 20060701 99999999<br />
84580 UROBILINOGEN, URINE $5.95 20060701 99999999<br />
84583 UROBILINOGEN, URINE $4.21 20060701 99999999<br />
84585 VANILLYMANDELIC ACID (VMA), URINE $21.42 20060701 99999999<br />
84586 VASOACTIVE INTESTINAL PEPTIDE (VIP) $46.25 20060701 99999999<br />
84588 VASOPRESSIN (ANTIDIURETIC HORMONE), RIA $46.91 20060701 99999999<br />
84590 VITAMIN A, BLOOD $16.02 20060701 99999999<br />
84591 VITAMIN, NOT OTHERWISE SPECIFIED $9.72 20060701 99999999<br />
84597 VITAMIN K $18.94 20060701 99999999<br />
84600 VOLATILES (ACETIC ANHYDRIDE, CARBON TETRACHLORIDE, $13.47 20060701 99999999<br />
84620 XYLOSE ABSORPTION TEST, BLOOD AND/OR URINE $9.93 20060701 99999999<br />
84630 ZINC, QUANTITATIVE $15.74 20060701 99999999<br />
84681 C-PEPTIDE, ANY METHOD $28.75 20060701 99999999<br />
84702 GONADOTROPIN, CHORIONIC $20.80 20060701 99999999<br />
84703 GONADOTROPIN, CHORIONIC $10.38 20060701 99999999<br />
84704 GONADOTROPIN, CHORIONIC (HCG); FREE BETA CHAIN $21.03 <strong>200801</strong>01 99999999<br />
84830<br />
OVULATION TESTS, BY VISUAL COLOR COMPARISON METHODS FOR<br />
HUMAN LUTEINIZING HORMON $8.41 20060701 99999999<br />
85002 BLEEDING TIME $6.22 20060701 99999999<br />
85004 BLOOD COUNT; AUTOMATED DIFFERENTIAL WBC COUNT $9.04 20060701 99999999<br />
85007 BLOOD COUNT $4.76 20060701 99999999<br />
85008<br />
BLOOD COUNT; MANUAL BLOOD SMEAR EXAMINATION WITHOUT<br />
DIFFERENTIAL PARAMETERS $4.76 20060701 99999999<br />
85009 BLOOD COUNT $5.14 20060701 99999999<br />
85013 BLOOD COUNT; SPUN MICROHEMATOCRIT $3.27 20060701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 253