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 27216 04 N M Y 550.90 27217 04 N M Y 599.35 27218 04 N M Y 599.35 27220 04 N M 412.00 27222 04 N M Y 412.00 27226 04 N M Y 930.90 27227 04 N M Y 930.90 27228 04 N M Y 1198.70 27230 04 N I 179.15 27232 04 N M Y 449.50 27235 04 N M Y 674.20 27236 04 N M Y 1019.70 27238 04 N I 183.80 27240 04 N M Y 449.50 27244 04 N M Y 933.80 27245 04 N M Y 933.80 27246 04 N I 167.00 27248 04 N M Y 779.70 27250 04 N M 242.80 27252 04 N M 284.90 27253 04 N M Y 599.35 Wednesday, April 01, 2009 Page 82 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 27254 04 N M Y 606.30 27256 04 N M 208.05 27257 04 N M Y 277.50 27258 04 N M Y 733.85 27259 04 N M Y 958.60 27265 04 N M 242.80 27266 04 N M Y 283.00 27267 04 1/1/2008 N M Y Y 220.82 27268 04 1/1/2008 N M Y Y 273.08 27269 04 1/1/2008 N M Y Y 655.58 27275 04 N M Y 240.00 27280 04 N M Y 958.60 27282 04 N M Y 958.60 27284 04 N M Y 898.95 27286 04 N M Y 1033.50 27290 04 N M Y Y 1678.65 27295 04 N M Y 1198.70 27299 04 Y M Y 27301 04 N M 242.10 27303 04 N M Y 298.20 27305 04 N M Y 374.55 Wednesday, April 01, 2009 Page 83 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 />
27254 <strong>04</strong> N M Y 606.30<br />
27256 <strong>04</strong> N M 208.05<br />
27257 <strong>04</strong> N M Y 277.50<br />
27258 <strong>04</strong> N M Y 733.85<br />
27259 <strong>04</strong> N M Y 958.60<br />
27265 <strong>04</strong> N M 242.80<br />
27266 <strong>04</strong> N M Y 283.00<br />
27267 <strong>04</strong> 1/1/2008 N M Y Y 220.82<br />
27268 <strong>04</strong> 1/1/2008 N M Y Y 273.08<br />
27269 <strong>04</strong> 1/1/2008 N M Y Y 655.58<br />
27275 <strong>04</strong> N M Y 240.00<br />
27280 <strong>04</strong> N M Y 958.60<br />
27282 <strong>04</strong> N M Y 958.60<br />
27284 <strong>04</strong> N M Y 898.95<br />
27286 <strong>04</strong> N M Y 1033.50<br />
27290 <strong>04</strong> N M Y Y 1678.65<br />
27295 <strong>04</strong> N M Y 1198.70<br />
27299 <strong>04</strong> Y M Y<br />
273<strong>01</strong> <strong>04</strong> N M 242.10<br />
27303 <strong>04</strong> N M Y 298.20<br />
27305 <strong>04</strong> N M Y 374.55<br />
Wednesday, April <strong>01</strong>, 20<strong>09</strong> Page 83 <strong>of</strong> 458
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