Procedure Code Procedure Description Pricing Indicator Rate Type Mod1 Mod2 Mod3 Mod4 Max Fee Max Fee Eff. Date Max Fee End Date PA
99211 OFF/OP EST MAY X REQ PHY/QHP PRXOVR DEF         NA NA NA N
99211 OFF/OP EST MAY X REQ PHY/QHP MAXFEE FAC         5.88 1/1/2024 12/31/2299 N
99211 OFF/OP EST MAY X REQ PHY/QHP MAXFEE NFF         15.37 1/1/2024 12/31/2299 N
H1005 PRENATALCARE ENHANCED SRV PK PRXOVR DEF         NA NA NA N
H1005 PRENATALCARE ENHANCED SRV PK MAXFEE DEF         246 1/1/2024 12/31/2299 N