Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois
Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois
Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty StateMax Surg Child Adult 33945 04 N M Y Y 2,894.30 33960 04 N I 453.70 33961 04 N I 295.60 33967 04 N I 230.20 33968 04 N M 162.00 33970 04 N M 689.50 33971 04 N M Y Y 334.80 33973 04 N M Y Y 689.50 33974 04 N M Y Y 419.25 33975 04 N M Y Y 1,350.15 33976 04 N M Y Y 1,674.20 33977 04 N M Y Y 1,215.15 33978 04 N M Y Y 1,458.20 33979 04 N M Y Y 730.85 33980 04 N M Y Y 787.90 33999 04 Y M Y Y 34001 04 N M Y 718.70 34051 04 N M Y 718.70 34101 04 N M Y 718.70 34111 04 N M Y 718.70 34151 04 N M Y 718.70 Wednesday, April 01, 2009 Page 134 of 458
Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty StateMax Surg Child Adult 34201 04 N M Y 718.70 34203 04 N M Y 718.70 34401 04 N M Y 718.70 34421 04 N M Y 718.70 34451 04 N M Y 898.95 34471 04 N M Y 599.35 34490 04 N M Y 599.35 34501 04 N M Y Y 480.00 34502 04 Y M Y Y 34510 04 N M Y Y 480.00 34520 04 N M Y Y 480.00 34530 04 N M Y Y 599.35 34800 04 N M Y 819.60 34802 04 N M Y 904.75 34803 04 N M Y Y 1,148.60 34804 04 N M Y 904.75 34805 04 N M Y Y 669.46 34806 04 1/1/2008 N M Y 59.78 34808 04 N M Y Y 156.10 34812 04 N M Y Y 255.70 34813 04 N M Y Y 181.55 Wednesday, April 01, 2009 Page 135 of 458
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Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty <strong>State</strong>Max Surg Child Adult<br />
33945 <strong>04</strong> N M Y Y 2,894.30<br />
33960 <strong>04</strong> N I 453.70<br />
33961 <strong>04</strong> N I 295.60<br />
33967 <strong>04</strong> N I 230.20<br />
33968 <strong>04</strong> N M 162.00<br />
33970 <strong>04</strong> N M 689.50<br />
33971 <strong>04</strong> N M Y Y 334.80<br />
33973 <strong>04</strong> N M Y Y 689.50<br />
33974 <strong>04</strong> N M Y Y 419.25<br />
33975 <strong>04</strong> N M Y Y 1,350.15<br />
33976 <strong>04</strong> N M Y Y 1,674.20<br />
33977 <strong>04</strong> N M Y Y 1,215.15<br />
33978 <strong>04</strong> N M Y Y 1,458.20<br />
33979 <strong>04</strong> N M Y Y 730.85<br />
33980 <strong>04</strong> N M Y Y 787.90<br />
33999 <strong>04</strong> Y M Y Y<br />
340<strong>01</strong> <strong>04</strong> N M Y 718.70<br />
34051 <strong>04</strong> N M Y 718.70<br />
341<strong>01</strong> <strong>04</strong> N M Y 718.70<br />
34111 <strong>04</strong> N M Y 718.70<br />
34151 <strong>04</strong> N M Y 718.70<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 134 <strong>of</strong> 458
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