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 64782 04 N M Y Y 240.00 64783 04 N M Y Y 120.60 64784 04 N M Y Y 359.30 64786 04 N M Y Y 470.15 64787 04 N M Y Y 124.70 64788 04 N I Y 139.60 34.00 64790 04 N M Y Y 359.30 64792 04 Y M Y Y 64795 04 N I 112.40 64802 04 N M Y Y 480.00 64804 04 N M Y Y 599.35 64809 04 N M Y Y 749.20 64818 04 N M Y Y 653.40 64820 04 Y M Y Y 64821 04 N M Y 407.40 64822 04 N M Y 407.40 64823 04 N M Y 471.00 64831 04 N M Y Y 252.45 64832 04 N M Y Y 139.00 64834 04 N M Y Y 299.70 64835 04 N M Y Y 599.35 Wednesday, April 01, 2009 Page 254 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 64836 04 N M Y Y 599.35 64837 04 N M Y Y 299.70 64840 04 N M Y Y 449.50 64856 04 N M Y Y 449.50 64857 04 N M Y Y 449.50 64858 04 N M Y Y 599.35 64859 04 N M Y Y 229.70 64861 04 N M Y Y 718.70 64862 04 N M Y Y 718.70 64864 04 N M Y Y 599.35 64865 04 N M Y Y 861.50 64866 04 N M Y Y 599.35 64868 04 N M Y Y 599.35 64870 04 N M Y Y 599.35 64872 04 N M Y Y 449.50 64874 04 N M Y Y 749.20 64876 04 N M Y Y 524.40 64885 04 N M Y Y 507.15 64886 04 N M Y Y 600.65 64890 04 N M Y Y 455.90 64891 04 N M Y Y 457.30 Wednesday, April 01, 2009 Page 255 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 />
64782 <strong>04</strong> N M Y Y 240.00<br />
64783 <strong>04</strong> N M Y Y 120.60<br />
64784 <strong>04</strong> N M Y Y 359.30<br />
64786 <strong>04</strong> N M Y Y 470.15<br />
64787 <strong>04</strong> N M Y Y 124.70<br />
64788 <strong>04</strong> N I Y 139.60 34.00<br />
64790 <strong>04</strong> N M Y Y 359.30<br />
64792 <strong>04</strong> Y M Y Y<br />
64795 <strong>04</strong> N I 112.40<br />
64802 <strong>04</strong> N M Y Y 480.00<br />
648<strong>04</strong> <strong>04</strong> N M Y Y 599.35<br />
648<strong>09</strong> <strong>04</strong> N M Y Y 749.20<br />
64818 <strong>04</strong> N M Y Y 653.40<br />
64820 <strong>04</strong> Y M Y Y<br />
64821 <strong>04</strong> N M Y 407.40<br />
64822 <strong>04</strong> N M Y 407.40<br />
64823 <strong>04</strong> N M Y 471.00<br />
64831 <strong>04</strong> N M Y Y 252.45<br />
64832 <strong>04</strong> N M Y Y 139.00<br />
64834 <strong>04</strong> N M Y Y 299.70<br />
64835 <strong>04</strong> N M Y Y 599.35<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 254 <strong>of</strong> 458
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