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 27087 04 N M Y 247.20 17.00 27090 04 N M Y 412.00 27091 04 N M Y 694.45 27093 04 N I 106.70 27095 04 N I 111.70 27096 04 N I 172.50 27097 04 N M Y 290.25 27098 04 N M Y 345.70 27100 04 N M Y 561.85 27105 04 N M Y 636.80 27110 04 N M Y 674.20 27111 04 N M Y 674.20 27120 04 N M Y 898.95 27122 04 N M Y 954.50 27125 04 N M Y 1026.65 27130 04 N M Y 1749.50 27132 04 N M Y 1798.05 27134 04 N M Y 1048.85 27137 04 N M Y 1048.85 27138 04 N M Y 1048.85 27140 04 N M Y 718.70 Wednesday, April 01, 2009 Page 80 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 27146 04 N M Y 718.70 27147 04 N M Y 839.35 27151 04 N M Y 1011.40 27156 04 N M Y 1123.70 27158 04 N M Y 583.00 27161 04 N M Y 749.20 27165 04 N M Y 898.95 27170 04 N M Y 898.95 27175 04 N M Y 599.35 27176 04 N M Y 599.35 27177 04 N M Y 958.60 27178 04 N M Y 958.60 27179 04 N M Y 839.35 27181 04 N M Y 958.60 27185 04 N M Y 779.70 27187 04 N M Y Y 950.50 27193 04 N I 170.80 27194 04 N I Y 272.40 27200 04 N M 149.80 27202 04 N M Y 374.55 27215 04 N M Y 674.20 Wednesday, April 01, 2009 Page 81 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 />
27087 <strong>04</strong> N M Y 247.20 17.00<br />
27<strong>09</strong>0 <strong>04</strong> N M Y 412.00<br />
27<strong>09</strong>1 <strong>04</strong> N M Y 694.45<br />
27<strong>09</strong>3 <strong>04</strong> N I 106.70<br />
27<strong>09</strong>5 <strong>04</strong> N I 111.70<br />
27<strong>09</strong>6 <strong>04</strong> N I 172.50<br />
27<strong>09</strong>7 <strong>04</strong> N M Y 290.25<br />
27<strong>09</strong>8 <strong>04</strong> N M Y 345.70<br />
27100 <strong>04</strong> N M Y 561.85<br />
27105 <strong>04</strong> N M Y 636.80<br />
27110 <strong>04</strong> N M Y 674.20<br />
27111 <strong>04</strong> N M Y 674.20<br />
27120 <strong>04</strong> N M Y 898.95<br />
27122 <strong>04</strong> N M Y 954.50<br />
27125 <strong>04</strong> N M Y 1026.65<br />
27130 <strong>04</strong> N M Y 1749.50<br />
27132 <strong>04</strong> N M Y 1798.05<br />
27134 <strong>04</strong> N M Y 1<strong>04</strong>8.85<br />
27137 <strong>04</strong> N M Y 1<strong>04</strong>8.85<br />
27138 <strong>04</strong> N M Y 1<strong>04</strong>8.85<br />
27140 <strong>04</strong> N M Y 718.70<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 80 <strong>of</strong> 458
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