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Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois

Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois

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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 />

94452 A <strong>04</strong> N I 14.29 14.28 28.57<br />

94453 A <strong>04</strong> N I 20.21 20.21 40.42<br />

94610 <strong>04</strong> N N 35.06<br />

94620 C <strong>04</strong> N I 12.30 29.80 42.10<br />

94621 <strong>04</strong> N I 59.00<br />

94640 <strong>04</strong> N N 14.50<br />

94642 <strong>04</strong> N N 22.05<br />

94644 <strong>04</strong> N N 17.87<br />

94645 <strong>04</strong> N N 6.92<br />

94660 <strong>09</strong> Y I<br />

94662 <strong>04</strong> Y I<br />

94664 <strong>04</strong> N N 15.20<br />

94667 <strong>04</strong> N N 15.20<br />

94668 <strong>04</strong> N N 8.20<br />

94680 C <strong>04</strong> N I 7.65 29.75 37.40<br />

94681 C <strong>04</strong> N I 7.70 36.70 44.40<br />

94690 C <strong>04</strong> N I 4.50 26.00 30.50<br />

94720 C <strong>04</strong> N I 9.40 28.00 37.40<br />

94725 C <strong>04</strong> N I 3.40 34.00 37.40<br />

94750 C <strong>04</strong> N I 4.45 17.70 22.15<br />

94760 C <strong>04</strong> N I 1.50 2.90 4.40<br />

Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 390 <strong>of</strong> 458

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