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 58100 04 N I 52.90 34.00 58110 04 N M 24.90 58120 04 N M 206.85 58140 04 N M Y 718.70 58145 04 N M Y 718.70 58146 04 N M Y 718.70 58150 04 N M Y 772.70 58152 04 N M Y 1096.05 58180 04 N M Y 652.05 58200 04 N M Y 772.70 58210 04 N M Y 1030.80 58240 04 N M Y 1423.45 58260 04 N M Y 725.60 58262 04 N M Y 725.60 58263 04 N M Y 725.60 58267 04 N M Y 856.00 58270 04 N M Y 856.00 58275 04 N M Y 875.40 58280 04 N M Y 800.50 58285 04 N M Y 950.30 58290 04 N M Y 725.60 Wednesday, April 01, 2009 Page 224 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 58291 04 N M Y 725.60 58292 04 N M Y 725.60 58293 04 N M Y 856.00 58294 04 N M Y 856.00 58300 04 N I 44.00 58301 04 N I 37.40 58340 04 N I 93.40 58346 04 N I 274.00 58350 04 N I 37.50 58353 04 N I Y 150.60 58356 04 N M 201.30 58400 04 N M Y 449.50 58410 04 N M Y 449.50 58520 04 N M Y 480.00 58540 04 N M Y 501.38 58541 04 1/1/2007 N M Y 433.94 58542 04 1/1/2007 N M Y 479.33 58543 04 1/1/2007 N M Y 487.55 58544 04 1/1/2007 N M Y 528.11 58545 04 N M Y 480.00 58546 04 N M Y 480.00 Wednesday, April 01, 2009 Page 225 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 />
58100 <strong>04</strong> N I 52.90 34.00<br />
58110 <strong>04</strong> N M 24.90<br />
58120 <strong>04</strong> N M 206.85<br />
58140 <strong>04</strong> N M Y 718.70<br />
58145 <strong>04</strong> N M Y 718.70<br />
58146 <strong>04</strong> N M Y 718.70<br />
58150 <strong>04</strong> N M Y 772.70<br />
58152 <strong>04</strong> N M Y 1<strong>09</strong>6.05<br />
58180 <strong>04</strong> N M Y 652.05<br />
58200 <strong>04</strong> N M Y 772.70<br />
58210 <strong>04</strong> N M Y 1030.80<br />
58240 <strong>04</strong> N M Y 1423.45<br />
58260 <strong>04</strong> N M Y 725.60<br />
58262 <strong>04</strong> N M Y 725.60<br />
58263 <strong>04</strong> N M Y 725.60<br />
58267 <strong>04</strong> N M Y 856.00<br />
58270 <strong>04</strong> N M Y 856.00<br />
58275 <strong>04</strong> N M Y 875.40<br />
58280 <strong>04</strong> N M Y 800.50<br />
58285 <strong>04</strong> N M Y 950.30<br />
58290 <strong>04</strong> N M Y 725.60<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 224 <strong>of</strong> 458
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