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 58548 04 1/1/2007 N M Y 924.56 58550 04 N M Y 725.60 58552 04 N M Y 725.00 58553 04 N M Y 725.00 58554 04 N M Y 725.00 58555 04 N I 95.75 58558 04 N I 145.80 58559 04 N I 160.80 58560 04 N I 160.80 58561 04 N M 361.85 58562 04 N M 361.85 58563 04 N I 300.43 58565 04 N M 327.45 58570 04 1/1/2008 N M Y Y 496.17 58571 04 1/1/2008 N M Y Y 542.05 58572 04 1/1/2008 N M Y Y 617.19 58573 04 1/1/2008 N M Y Y 693.59 58578 04 Y M 58579 04 Y M 58600 04 N M Y 327.45 58605 04 N M Y 327.45 Wednesday, April 01, 2009 Page 226 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 58611 04 N M Y 97.30 58615 04 N M 327.45 58660 04 N M Y 302.40 58661 04 N M Y 480.00 58662 04 N M Y 302.40 58670 04 N M 363.45 58671 04 N M 363.45 58672 09 Y M 58673 04 N M Y 480.00 58679 04 Y M 58700 04 N M Y 481.90 58720 04 N M Y 525.85 58740 04 N M Y 480.00 58752 09 Y M 58770 04 N M Y 480.00 58800 04 N M Y 359.30 58805 04 N M Y 480.00 58820 04 N M Y 240.00 58822 04 N M Y 480.00 58823 04 N M 302.90 58825 04 Y M Y Wednesday, April 01, 2009 Page 227 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 />
58548 <strong>04</strong> 1/1/2007 N M Y 924.56<br />
58550 <strong>04</strong> N M Y 725.60<br />
58552 <strong>04</strong> N M Y 725.00<br />
58553 <strong>04</strong> N M Y 725.00<br />
58554 <strong>04</strong> N M Y 725.00<br />
58555 <strong>04</strong> N I 95.75<br />
58558 <strong>04</strong> N I 145.80<br />
58559 <strong>04</strong> N I 160.80<br />
58560 <strong>04</strong> N I 160.80<br />
58561 <strong>04</strong> N M 361.85<br />
58562 <strong>04</strong> N M 361.85<br />
58563 <strong>04</strong> N I 300.43<br />
58565 <strong>04</strong> N M 327.45<br />
58570 <strong>04</strong> 1/1/2008 N M Y Y 496.17<br />
58571 <strong>04</strong> 1/1/2008 N M Y Y 542.05<br />
58572 <strong>04</strong> 1/1/2008 N M Y Y 617.19<br />
58573 <strong>04</strong> 1/1/2008 N M Y Y 693.59<br />
58578 <strong>04</strong> Y M<br />
58579 <strong>04</strong> Y M<br />
58600 <strong>04</strong> N M Y 327.45<br />
58605 <strong>04</strong> N M Y 327.45<br />
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