| Procedure Code | Procedure Description | Pricing Indicator | Rate Type | Mod1 | Mod2 | Mod3 | Mod4 | Max Fee | Max Fee Eff. Date | Max Fee End Date | PA |
| T1017 | TARGETED CASE MANAGEMENT | MAXFEE | HM2 | 12.21 | 7/1/2012 | 12/31/2299 | N | ||||
| T1017 | TARGETED CASE MANAGEMENT | MAXFEE | HM1 | 14.38 | 7/1/2012 | 12/31/2299 | N |