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 66150 04 N M 718.70 66155 04 N M 718.70 66160 04 N M 718.70 66165 04 N M 599.35 66170 04 N M Y 718.70 66172 04 N M Y 810.10 66180 04 N M Y 799.70 66185 04 N M Y 351.00 66220 04 N M 550.90 66225 04 N M 675.10 66250 04 Y M 66500 04 N M 149.80 66505 04 N M 240.00 66600 04 N M 581.30 66605 04 N M 581.30 66625 04 N M 581.30 66630 04 N M 581.30 66635 04 N M 581.30 66680 04 N M 471.70 66682 04 N M Y Y 471.70 66700 04 N M 341.30 Wednesday, April 01, 2009 Page 260 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 66710 04 N M 341.30 66711 04 N M 341.30 66720 04 N M Y 341.30 66740 04 N M 569.30 66761 04 N M 449.50 66762 04 N M 449.50 66770 04 N M 374.55 66820 04 N M Y 299.70 66821 04 N M 299.70 66825 04 N M Y 299.70 66830 04 N M Y 374.55 66840 04 N M Y 751.90 66850 04 N M Y 751.90 66852 04 N M Y 751.90 66920 04 N M Y 751.90 66930 04 N M Y 751.90 66940 04 N M Y 751.90 66982 04 N M 587.60 66983 04 N M Y 1051.60 66984 04 N M 1051.60 66985 04 N M 574.75 Wednesday, April 01, 2009 Page 261 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 />
66710 <strong>04</strong> N M 341.30<br />
66711 <strong>04</strong> N M 341.30<br />
66720 <strong>04</strong> N M Y 341.30<br />
66740 <strong>04</strong> N M 569.30<br />
66761 <strong>04</strong> N M 449.50<br />
66762 <strong>04</strong> N M 449.50<br />
66770 <strong>04</strong> N M 374.55<br />
66820 <strong>04</strong> N M Y 299.70<br />
66821 <strong>04</strong> N M 299.70<br />
66825 <strong>04</strong> N M Y 299.70<br />
66830 <strong>04</strong> N M Y 374.55<br />
66840 <strong>04</strong> N M Y 751.90<br />
66850 <strong>04</strong> N M Y 751.90<br />
66852 <strong>04</strong> N M Y 751.90<br />
66920 <strong>04</strong> N M Y 751.90<br />
66930 <strong>04</strong> N M Y 751.90<br />
66940 <strong>04</strong> N M Y 751.90<br />
66982 <strong>04</strong> N M 587.60<br />
66983 <strong>04</strong> N M Y 1051.60<br />
66984 <strong>04</strong> N M 1051.60<br />
66985 <strong>04</strong> N M 574.75<br />
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