| Procedure Code | Procedure Description | Pricing Indicator | Rate Type | Mod1 | Mod2 | Mod3 | Mod4 | Max Fee | Max Fee Eff. Date | Max Fee End Date | PA |
| A0040 | HELICOPTER AMBULANCE SERVICE | PRXOVR | DEF | NA | NA | NA | N | ||||
| A0040 | HELICOPTER AMBULANCE SERVICE | MANUAL | DEF | NA | NA | NA | N | ||||
| A0320 | AMB BASIC NON-ER + SUPPLIES | PRXOVR | DEF | NA | NA | NA | S | ||||
| A0320 | AMB BASIC NON-ER + SUPPLIES | MAXFEE | DEF | NA | S | ||||||
| A0322 | AMB BASIC EMERG + SUPPLIES | PRXOVR | DEF | NA | NA | NA | S | ||||
| A0322 | AMB BASIC EMERG + SUPPLIES | MAXFEE | DEF | NA | S | ||||||
| A0324 | ADV NON-ER SERV SEP MILEAGE | PRXOVR | DEF | NA | NA | NA | S | ||||
| A0324 | ADV NON-ER SERV SEP MILEAGE | MAXFEE | DEF | NA | S | ||||||
| A0326 | ADV NON-ER NO SERV SEP MILE | PRXOVR | DEF | NA | NA | NA | S | ||||
| A0326 | ADV NON-ER NO SERV SEP MILE | MAXFEE | DEF | NA | S | ||||||
| A0328 | ADV ER NO SERV SEP MILEAGE | PRXOVR | DEF | NA | NA | NA | S | ||||
| A0328 | ADV ER NO SERV SEP MILEAGE | MAXFEE | DEF | NA | S | ||||||
| A0330 | ADV ER SPEC SERV SEP MILE | PRXOVR | DEF | NA | NA | NA | S | ||||
| A0330 | ADV ER SPEC SERV SEP MILE | MAXFEE | DEF | NA | S | ||||||
| A0424 | EXTRA AMBULANCE ATTENDANT | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0424 | EXTRA AMBULANCE ATTENDANT | MAXFEE | DEF | 15 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0425 | GROUND MILEAGE | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0425 | GROUND MILEAGE | MAXFEE | DEF | 2 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0426 | ALS 1 | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0426 | ALS 1 | MAXFEE | DEF | 120 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0427 | ALS1-EMERGENCY | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0427 | ALS1-EMERGENCY | MAXFEE | DEF | 170 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0428 | BLS | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0428 | BLS | MAXFEE | DEF | 115 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0429 | BLS-EMERGENCY | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0429 | BLS-EMERGENCY | MAXFEE | DEF | 120 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0430 | FIXED WING AIR TRANSPORT | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0430 | FIXED WING AIR TRANSPORT | MAXFEE | DEF | 1550 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0431 | ROTARY WING AIR TRANSPORT | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0431 | ROTARY WING AIR TRANSPORT | MAXFEE | DEF | 1800 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0433 | ALS 2 | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0433 | ALS 2 | MAXFEE | DEF | 180 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0434 | SPECIALTY CARE TRANSPORT | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0434 | SPECIALTY CARE TRANSPORT | MAXFEE | DEF | 190 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0435 | FIXED WING AIR MILEAGE | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0435 | FIXED WING AIR MILEAGE | MAXFEE | DEF | 3 | 1/1/2020 | 12/31/2299 | Y N | ||||
| A0436 | ROTARY WING AIR MILEAGE | PRXOVR | DEF | NA | NA | NA | Y N | ||||
| A0436 | ROTARY WING AIR MILEAGE | MAXFEE | DEF | 7.75 | 1/1/2020 | 12/31/2299 | Y N |