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 44207 04 N M Y Y 958.60 44208 04 N M Y Y 951.80 44210 04 N M Y Y 1255.88 44211 04 N M Y Y 1079.30 44212 04 N M Y Y 1198.70 44213 04 N I Y 110.46 44227 04 N I Y 864.06 44238 04 Y M Y Y 44300 04 N M Y Y 599.35 44310 04 N M Y Y 629.90 44312 04 N M Y Y 374.55 44314 04 N M Y Y 599.35 44316 04 N M Y Y 535.45 44320 04 N M Y Y 535.45 44322 04 N M Y Y 535.45 44340 04 N M Y Y 299.70 44345 04 N M Y Y 480.00 44346 04 N M Y Y 951.80 44360 04 N I 264.25 56.70 44361 04 N I 285.40 56.70 44363 04 N M Y 285.40 56.70 Wednesday, April 01, 2009 Page 176 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 44364 04 N M 356.70 56.70 44365 04 N M 356.70 44366 04 N M 285.40 56.70 44369 04 N M 285.40 56.70 44370 04 N M 158.30 44372 04 N M 285.40 44373 04 N M 356.70 44376 04 N I 318.30 44377 04 N I 318.30 44378 04 N M 318.30 44379 04 N M 258.55 44380 04 N I 182.30 56.70 44382 04 N I 218.00 56.70 44383 04 N I 88.30 44385 04 N I 182.30 56.70 44386 04 N I 182.30 56.70 44388 04 N I 192.85 56.70 44389 04 N I 192.85 56.70 44390 04 N I 192.85 56.70 44391 04 N I 283.40 56.70 44392 04 N M 230.80 56.70 Wednesday, April 01, 2009 Page 177 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 />
44364 <strong>04</strong> N M 356.70 56.70<br />
44365 <strong>04</strong> N M 356.70<br />
44366 <strong>04</strong> N M 285.40 56.70<br />
44369 <strong>04</strong> N M 285.40 56.70<br />
44370 <strong>04</strong> N M 158.30<br />
44372 <strong>04</strong> N M 285.40<br />
44373 <strong>04</strong> N M 356.70<br />
44376 <strong>04</strong> N I 318.30<br />
44377 <strong>04</strong> N I 318.30<br />
44378 <strong>04</strong> N M 318.30<br />
44379 <strong>04</strong> N M 258.55<br />
44380 <strong>04</strong> N I 182.30 56.70<br />
44382 <strong>04</strong> N I 218.00 56.70<br />
44383 <strong>04</strong> N I 88.30<br />
44385 <strong>04</strong> N I 182.30 56.70<br />
44386 <strong>04</strong> N I 182.30 56.70<br />
44388 <strong>04</strong> N I 192.85 56.70<br />
44389 <strong>04</strong> N I 192.85 56.70<br />
44390 <strong>04</strong> N I 192.85 56.70<br />
44391 <strong>04</strong> N I 283.40 56.70<br />
44392 <strong>04</strong> N M 230.80 56.70<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 177 <strong>of</strong> 458
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