| Procedure Code | Procedure Description | Pricing Indicator | Rate Type | Mod1 | Mod2 | Mod3 | Mod4 | Max Fee | Max Fee Eff. Date | Max Fee End Date | PA |
| T2031 | ASSIST LIVING WAIVER/DIEM | MAXFEE | ALW | 76.67 | 11/1/2021 | 12/31/2299 | N | ||||
| T2038 | COMM TRANS WAIVER/SERVICE | MAXFEE | ALW | 2000 | 7/1/2019 | 12/31/2299 | N |