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 24400 04 N M Y 541.05 24410 04 N M Y 481.65 24420 04 N M Y 898.95 24430 04 N M Y 636.80 24435 04 N M Y 958.60 24470 04 N M Y 374.55 24495 04 N M Y 299.70 24498 04 N M Y Y 491.50 24500 04 N M 153.95 24505 04 N M 295.50 24515 04 N M Y 624.30 24516 04 N M Y 624.30 24530 04 N M 299.70 24535 04 N M 334.40 24538 04 N M Y 405.10 24545 04 N M Y 718.70 24546 04 N M Y 718.70 24560 04 N M 199.75 24565 04 N M 242.80 24566 04 N M Y 257.30 24575 04 N M Y 718.70 Wednesday, April 01, 2009 Page 60 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 24576 04 N M 188.70 24577 04 N M 245.55 24579 04 N M Y 718.70 24582 04 N M Y 405.10 24586 04 N M Y 480.65 24587 04 N M Y 1123.70 24600 04 N M 208.05 24605 04 N M 242.80 24615 04 N M Y 419.00 24620 04 N M 259.40 24635 04 N M Y 482.80 24640 04 N M 180.30 24650 04 N I 142.90 24655 04 N M Y 208.05 24665 04 N M Y 400.90 24666 04 N M Y 449.50 24670 04 N M 181.65 24675 04 N M 206.70 24685 04 N M Y 556.35 24800 04 N M Y 718.70 24802 04 N M Y 839.35 Wednesday, April 01, 2009 Page 61 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 />
24576 <strong>04</strong> N M 188.70<br />
24577 <strong>04</strong> N M 245.55<br />
24579 <strong>04</strong> N M Y 718.70<br />
24582 <strong>04</strong> N M Y 405.10<br />
24586 <strong>04</strong> N M Y 480.65<br />
24587 <strong>04</strong> N M Y 1123.70<br />
24600 <strong>04</strong> N M 208.05<br />
24605 <strong>04</strong> N M 242.80<br />
24615 <strong>04</strong> N M Y 419.00<br />
24620 <strong>04</strong> N M 259.40<br />
24635 <strong>04</strong> N M Y 482.80<br />
24640 <strong>04</strong> N M 180.30<br />
24650 <strong>04</strong> N I 142.90<br />
24655 <strong>04</strong> N M Y 208.05<br />
24665 <strong>04</strong> N M Y 400.90<br />
24666 <strong>04</strong> N M Y 449.50<br />
24670 <strong>04</strong> N M 181.65<br />
24675 <strong>04</strong> N M 206.70<br />
24685 <strong>04</strong> N M Y 556.35<br />
24800 <strong>04</strong> N M Y 718.70<br />
24802 <strong>04</strong> N M Y 839.35<br />
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