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 26034 04 N M Y 240.00 26035 04 N M Y 321.65 26037 04 N M Y 265.20 26040 04 N M Y 264.90 26045 04 N M Y 449.50 26055 04 N M Y 235.80 26060 04 N I Y 107.90 26070 04 N M Y 224.70 26075 04 N M Y 224.70 26080 04 N M Y 187.30 26100 04 N M Y 299.70 26105 04 N M Y 262.20 26110 04 N M Y 187.30 26115 04 N M Y 149.80 26116 04 N M Y 224.70 26117 04 Y M Y Y 26121 04 N M Y 449.50 26123 04 N M Y 524.40 26125 04 Y M Y 26130 04 N M Y 374.55 26135 04 N M Y 270.60 Wednesday, April 01, 2009 Page 70 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 26140 04 N M Y 245.35 26145 04 N M Y 252.80 26160 04 N M Y 210.10 34.00 26170 04 N M Y 240.00 26180 04 N M Y 240.00 26185 04 Y M Y 26200 04 N M Y 299.70 26205 04 N M Y 374.55 26210 04 N M Y 224.70 26215 04 N M Y 314.95 26230 04 N M Y 299.70 26235 04 N M Y 224.70 26236 04 N M Y 204.05 26250 04 N M Y 449.50 26255 04 N M Y 524.40 26260 04 N M Y 374.55 26261 04 N M Y 449.50 26262 04 N M Y 299.70 26320 04 N M Y 233.00 26340 04 N I 139.70 26350 04 N M Y 274.40 Wednesday, April 01, 2009 Page 71 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 />
26140 <strong>04</strong> N M Y 245.35<br />
26145 <strong>04</strong> N M Y 252.80<br />
26160 <strong>04</strong> N M Y 210.10 34.00<br />
26170 <strong>04</strong> N M Y 240.00<br />
26180 <strong>04</strong> N M Y 240.00<br />
26185 <strong>04</strong> Y M Y<br />
26200 <strong>04</strong> N M Y 299.70<br />
26205 <strong>04</strong> N M Y 374.55<br />
26210 <strong>04</strong> N M Y 224.70<br />
26215 <strong>04</strong> N M Y 314.95<br />
26230 <strong>04</strong> N M Y 299.70<br />
26235 <strong>04</strong> N M Y 224.70<br />
26236 <strong>04</strong> N M Y 2<strong>04</strong>.05<br />
26250 <strong>04</strong> N M Y 449.50<br />
26255 <strong>04</strong> N M Y 524.40<br />
26260 <strong>04</strong> N M Y 374.55<br />
26261 <strong>04</strong> N M Y 449.50<br />
26262 <strong>04</strong> N M Y 299.70<br />
26320 <strong>04</strong> N M Y 233.00<br />
26340 <strong>04</strong> N I 139.70<br />
26350 <strong>04</strong> N M Y 274.40<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 71 <strong>of</strong> 458
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