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 24130 04 N M Y 492.55 24134 04 N M Y 351.00 24136 04 N M Y 262.80 24138 04 N M Y 254.80 24140 04 N M Y 480.00 24145 04 N M Y 480.00 24147 04 N M Y 480.00 24149 04 Y M Y 24150 04 N M Y 1198.70 24151 04 N M Y 1198.70 24152 04 N M Y 958.60 24153 04 N M Y 1048.85 24155 04 N M Y 749.20 24160 04 N M Y 299.70 24164 04 N M 492.55 24200 04 N M 169.30 24201 04 N M Y 245.55 24220 04 N I 105.15 24300 04 N I 66.70 24301 04 N M Y 453.70 24305 04 N M Y 359.30 Wednesday, April 01, 2009 Page 58 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 24310 04 N M Y 188.70 24320 04 N M Y 599.35 24330 04 N M Y 599.35 24331 04 N M Y 599.35 24332 04 N M Y 326.30 24340 04 N M Y 299.70 24341 04 N M Y 274.20 24342 04 N M Y 535.45 24343 04 N M Y 430.15 24344 04 N M Y 651.95 24345 04 N M Y 430.15 24346 04 N M Y 651.95 24357 04 1/1/2008 N M Y 233.94 24358 04 1/1/2008 N M Y 275.71 24359 04 1/1/2008 N M Y 341.04 24360 04 N M Y 718.70 24361 04 N M Y 1123.70 24362 04 N M Y 1123.70 24363 04 N M Y 1123.70 24365 04 N M Y 1123.70 24366 04 N M Y 1123.70 Wednesday, April 01, 2009 Page 59 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 />
24130 <strong>04</strong> N M Y 492.55<br />
24134 <strong>04</strong> N M Y 351.00<br />
24136 <strong>04</strong> N M Y 262.80<br />
24138 <strong>04</strong> N M Y 254.80<br />
24140 <strong>04</strong> N M Y 480.00<br />
24145 <strong>04</strong> N M Y 480.00<br />
24147 <strong>04</strong> N M Y 480.00<br />
24149 <strong>04</strong> Y M Y<br />
24150 <strong>04</strong> N M Y 1198.70<br />
24151 <strong>04</strong> N M Y 1198.70<br />
24152 <strong>04</strong> N M Y 958.60<br />
24153 <strong>04</strong> N M Y 1<strong>04</strong>8.85<br />
24155 <strong>04</strong> N M Y 749.20<br />
24160 <strong>04</strong> N M Y 299.70<br />
24164 <strong>04</strong> N M 492.55<br />
24200 <strong>04</strong> N M 169.30<br />
242<strong>01</strong> <strong>04</strong> N M Y 245.55<br />
24220 <strong>04</strong> N I 105.15<br />
24300 <strong>04</strong> N I 66.70<br />
243<strong>01</strong> <strong>04</strong> N M Y 453.70<br />
24305 <strong>04</strong> N M Y 359.30<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 58 <strong>of</strong> 458
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