Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
DD148	CP-BENEFITS EDUC & ANAYLSIS IO; 1 UNIT	MAXFEE	WVR					334.08	1/1/2022	12/31/2299	N
DD149	CP-CAREER DISCOVY GRP A & A-1 IO; 1 UNIT	MAXFEE	WVR					1127.57	1/1/2022	12/31/2299	N
DD150	CP-CAREER DISCOVERY GROUP B IO; 1 UNIT	MAXFEE	WVR					1691.35	1/1/2022	12/31/2299	N
DD151	CP-CAREER DISCOVERY GROUP C IO; 1 UNIT	MAXFEE	WVR					2255.14	1/1/2022	12/31/2299	N
DD152	CP-CAREER EXPLRTN AGNCY IO; 15 MIN UNIT	MAXFEE	WVR					14.84	1/1/2022	12/31/2299	N
DD153	CP-CAREER EXPLRTN INDP IO; 15 MIN UNIT	MAXFEE	WVR					9.59	1/1/2022	12/31/2299	N
DD153	CP-CAREER EXPLRTN INDP IO; 15 MIN UNIT	MAXFEE	OVR					12.26	1/1/2022	12/31/2299	N
DD154	CP-SELF EMPLOYMENT PLAN IO; 1 UNIT	MAXFEE	WVR					845.68	1/1/2022	12/31/2299	N
DD155	CP-JOB DEVELPMNT AGNCY IO; 15 MIN UNIT	MAXFEE	WVR					14.84	1/1/2022	12/31/2299	N
DD156	CP-JOB DEVELPMNT INDP IO; 15 MIN UNIT	MAXFEE	WVR					9.59	1/1/2022	12/31/2299	N
DD156	CP-JOB DEVELPMNT INDP IO; 15 MIN UNIT	MAXFEE	OVR					12.26	1/1/2022	12/31/2299	N
DD157	CP-EMPLYMT LAUNCH AGNCY IO; 15 MIN UNIT	MAXFEE	WVR					14.84	1/1/2022	12/31/2299	N
DD158	CP-EMPLYMT LAUNCH INDP IO; 15 MIN UNIT	MAXFEE	WVR					9.59	1/1/2022	12/31/2299	N
DD158	CP-EMPLYMT LAUNCH INDP IO; 15 MIN UNIT	MAXFEE	OVR					12.26	1/1/2022	12/31/2299	N
DD159	CP-SITUATIONAL OB & ASSESSMNT IO; 1 UNIT	MAXFEE	WVR					845.68	1/1/2022	12/31/2299	N
DD160	CP-WORKSITE ACCESS AGNCY IO; 15 MIN UNIT	MAXFEE	WVR					14.84	1/1/2022	12/31/2299	N
DD161	CP-WORKSITE ACCESS INDP IO; 15 MIN UNIT	MAXFEE	WVR					9.59	1/1/2022	12/31/2299	N
DD161	CP-WORKSITE ACCESS INDP IO; 15 MIN UNIT	MAXFEE	OVR					12.26	1/1/2022	12/31/2299	N
DD192	IND EMPLYMNT SUPPT IO AGNCY; 15 MIN UNIT	MAXFEE	WVR					12.15	1/1/2022	12/31/2299	N
DD193	IND EMPLYMNT SUPPT IO INDP; 15 MIN UNIT	MAXFEE	WVR					7.90	1/1/2022	12/31/2299	N
DD193	IND EMPLYMNT SUPPT IO INDP; 15 MIN UNIT	MAXFEE	OVR					10.14	1/1/2022	12/31/2299	N
DD198	GRP EMPL SUPPORT IO GROUP A; 15 MIN UNIT	MAXFEE	WVR					3.03	1/1/2022	12/31/2299	N
DD199	GRP EMPL SUPPORT IO GRP A-1; 15 MIN UNIT	MAXFEE	WVR					2.59	1/1/2022	12/31/2299	N
DD200	GRP EMPL SUPPORT IO GRP B; 15 MIN UNIT	MAXFEE	WVR					4.44	1/1/2022	12/31/2299	N
DD201	GRP EMPL SUPPORT IO GRP C; 15 MIN UNIT	MAXFEE	WVR					6.55	1/1/2022	12/31/2299	N
DD218	MONEY MANAGEMENT-IO AGNCY; 15 MIN UNIT	MAXFEE	WVR					5.20	4/1/2017	12/31/2299	N
DD219	MONEY MANAGEMENT-IO INDP; 15 MIN UNIT	MAXFEE	WVR					4.49	4/1/2017	12/31/2299	N
DD219	MONEY MANAGEMENT-IO INDP; 15 MIN UNIT	MAXFEE	OVR					5.94	4/1/2017	12/31/2299	N
DD224	GROUP EMPLOYMENT SUPPORT IO GRP A; DAILY	MAXFEE	WVR					38.50	1/1/2022	12/31/2299	N
DD225	GROUP EMPLOYMENT SUPPORT IO GRP A-1; DAY	MAXFEE	WVR					29	1/1/2022	12/31/2299	N
DD226	GROUP EMPLOYMENT SUPPORT IO GRP B; DAILY	MAXFEE	WVR					69.25	1/1/2022	12/31/2299	N
DD227	GROUP EMPLOYMENT SUPPORT IO GRP C; DAILY	MAXFEE	WVR					115.75	1/1/2022	12/31/2299	N
DD236	SHARED LIVING AGENCY	MAXFEE	WVR					210.04	1/1/2022	12/31/2299	N
DD237	SHARED LIVING INDEPENDENT	MAXFEE	WVR					184.38	1/1/2022	12/31/2299	N
DD238	IOW PART/DIR HPC; 15 MINUTE UNIT	MAXFEE	WVR					7.81	1/1/2022	12/31/2299	N
DD238	IOW PART/DIR HPC; 15 MINUTE UNIT	MAXFEE	OVR					10.75	1/1/2022	12/31/2299	N
DD239	IOW PART/DIR OSOC HPC; 15 MINUTE UNIT	MAXFEE	WVR					3.66	1/1/2022	12/31/2299	N
DD239	IOW PART/DIR OSOC HPC; 15 MINUTE UNIT	MAXFEE	OVR					5.49	1/1/2022	12/31/2299	N
DD249	HPC COMP BASED DAILY UNIT AGENCY	IODBUS	WVR					NA	NA	NA	N
DD250	IOW COMP BASED HMKR PERS CARE; 15 MIN	MAXFEE	WVR					8.57	1/1/2022	12/31/2299	N
DD250	IOW COMP BASED HMKR PERS CARE; 15 MIN	MAXFEE	OVR					9.61	1/1/2022	12/31/2299	N
DD251	IOW COMPBASED HMKRPERS CARE-STF 2;15 MIN	MAXFEE	WVR					15.24	1/1/2022	12/31/2299	N
DD252	IOW COMPBASED HMKRPERS CARE-STF 3;15 MIN	MAXFEE	WVR					21.92	1/1/2022	12/31/2299	N
DD253	IOW COMPBASED HMKRPERS CARE-STF 4;15 MIN	MAXFEE	WVR					28.58	1/1/2022	12/31/2299	N
DD254	IOW COMPBASED HMKRPERS CARE-STF 5;15 MIN	MAXFEE	WVR					35.26	1/1/2022	12/31/2299	N
DD265	IO-COMMUNITY TRANSITION	MAXFEE	WVR					2000	1/1/2019	12/31/2299	N
DD266	IO-ASSISTIVE TECHNOLOGY CONSULTATION	MAXFEE	WVR					137.44	1/1/2019	12/31/2299	N
DD267	IO-ASSISTIVE TECHNOLOGY EQUIPMENT	MAXFEE	WVR					5000	1/1/2019	12/31/2299	N
DD268	IO-ASSISTIVE TECHNOLOGY SUPPORT	MAXFEE	WVR					5.45	1/1/2019	12/31/2299	N
DD278	IO - BEST DAY UNIT - A1	MAXFEE	WVR					NA			N
DD279	IO - BEST DAY UNIT - A	MAXFEE	WVR					NA			N
DD280	IO - BEST DAY UNIT - B	MAXFEE	WVR					NA			N
DD281	IO - BEST DAY UNIT - C	MAXFEE	WVR					NA			N
DD282	IO - BEST 15 MINUTE UNIT - A1	MAXFEE	WVR					NA			N
DD283	IO - BEST 15 MINUTE UNIT - A	MAXFEE	WVR					NA			N
DD284	IO - BEST 15 MINUTE UNIT - B	MAXFEE	WVR					NA			N
DD285	IO - BEST 15 MINUTE UNIT - C	MAXFEE	WVR					NA			N
DD286	IO - BEST 15 MIN UNIT WITH INT - A1	MAXFEE	WVR					NA			N
DD287	IO - BEST 15 MIN UNIT WITH INT - A	MAXFEE	WVR					NA			N
DD288	IO - BEST 15 MIN UNIT WITH INT - B	MAXFEE	WVR					NA			N
DD289	IO - BEST 15 MIN UNIT WITH INT - C	MAXFEE	WVR					NA			N
DD314	IO - SELF DIRECTED TRANSPORTATION - ITEM	MAXFEE	WVR					104	7/1/2022	12/31/2299	N
DD315	IO - SELF DIR TRANS - MILE - MOD VEHICLE	MAXFEE	WVR					0.60	7/1/2022	12/31/2299	N
DD316	IO - SELF DIR TRANS - MILE - NON MOD VEH	MAXFEE	WVR					1.04	7/1/2022	12/31/2299	N
DD317	IO - SELF DIRECTED TRANSPORTATION-TRIP	MAXFEE	WVR					104	7/1/2022	12/31/2299	N
MR001	ADULT DAY SUPPT-IO GROUP A-1; 15 MINUTE	MAXFEE	WVR					2.59	1/1/2022	12/31/2299	N
MR002	ADULT DAY SUPPT-IO GROUP A; 15 MINUTE	MAXFEE	WVR					3.03	1/1/2022	12/31/2299	N
MR003	ADULT DAY SUPPT-IO GROUP B; 15 MINUTE	MAXFEE	WVR					4.44	1/1/2022	12/31/2299	N
MR004	ADULT DAY SUPPORT-IO GROUP C; 15 MINUTE	MAXFEE	WVR					6.55	1/1/2022	12/31/2299	N
MR005	ADULT DAY SUPPT-IO GROUP A-1; DAILY	MAXFEE	WVR					51.75	1/1/2022	12/31/2299	N
MR006	ADULT DAY SUPPT-IO GROUP A; DAILY	MAXFEE	WVR					62.75	1/1/2022	12/31/2299	N
MR007	ADULT DAY SUPPT-IO GROUP B; DAILY	MAXFEE	WVR					98	1/1/2022	12/31/2299	N
MR008	ADULT DAY SUPPORT-IO GROUP C; DAILY	MAXFEE	WVR					150.75	1/1/2022	12/31/2299	N
MR017	VOC.HAB.-IO GROUP A-1; 15 MINUTE UNIT	MAXFEE	WVR					2.59	1/1/2022	12/31/2299	N
MR018	VOC.HAB.-IO GROUP A; 15 MINUTE UNIT	MAXFEE	WVR					3.03	1/1/2022	12/31/2299	N
MR019	VOC.HAB.-IO GROUP B; 15 MINUTE UNIT	MAXFEE	WVR					4.44	1/1/2022	12/31/2299	N
MR020	VOC.HAB.-IO GROUP C; 15 MINUTE UNIT	MAXFEE	WVR					6.55	1/1/2022	12/31/2299	N
MR021	VOC.HAB.-IO GROUP A-1; DAILY	MAXFEE	WVR					51.75	1/1/2022	12/31/2299	N
MR022	VOC.HAB.-IO GROUP A; DAILY	MAXFEE	WVR					62.75	1/1/2022	12/31/2299	N
MR023	VOC.HAB.-IO GROUP B; DAILY	MAXFEE	WVR					98	1/1/2022	12/31/2299	N
MR024	VOC. HAB.-IO GROUP C; DAILY	MAXFEE	WVR					150.75	1/1/2022	12/31/2299	N
MR067	NON-MEDICAL TRANSPO.; IO PER MILE	MAXFEE	OTH					1.04	1/1/2022	12/31/2299	N
MR067	NON-MEDICAL TRANSPO.; IO PER MILE	MAXFEE	WVR					0.60	1/1/2022	12/31/2299	N
MR069	NON-MEDICAL TRANSPO.; IO PER TRIP	MAXFEE	WVR					20.89	1/1/2022	12/31/2299	N
MR106	NON-MEDICAL TRANS TAXI-LIVERY-BUS IO WVR	MAXFEE	WVR					104	1/1/2022	12/31/2299	N
MR107	ENVIRONMENTAL ACCESSIBILITY ADAPTATIONS	MAXFEE	WVR					10000	9/1/2017	12/31/2299	N
MR108	HPC DAILY BILLING UNIT AGENCY	IODBUS	WVR					NA	NA	NA	N
MR109	HPC DAILY BILLING UNIT INDPENDENT	IODBUS	WVR					NA	NA	NA	N
MR110	REMOTE MONITORING UNPAID SUPPORT HOUR	MAXFEE	WVR					6.88	1/1/2019	12/31/2299	N
MR111	REMOTE MONITORING PAID SUPPORT	MAXFEE	WVR					10.24	1/1/2019	12/31/2299	N
MR115	RESIDENTIAL RESPITE ICF MR DAILY RATE	MAXFEE	WVR					220.48	1/1/2022	12/31/2299	N
MR116	RESIDENTIAL RESPITE LICENSED FACILITY	MAXFEE	WVR					143.31	1/1/2022	12/31/2299	N
MR117	COMMUNITY RESPITE FULL DAY NO MOD.	MAXFEE	WVR					175.83	1/1/2022	12/31/2299	N
MR118	COMMUNITY RESPITE FULL DAY MA	MAXFEE	WVR					183.51	1/1/2022	12/31/2299	N
MR119	COMMUNITY RESPITE FULL DAY BS	MAXFEE	WVR					216.15	1/1/2022	12/31/2299	N
MR120	COMMUNITY RESPITE FULL DAY MABS	MAXFEE	WVR					223.83	1/1/2022	12/31/2299	N
MR121	COMMUNITY RESPITE PARTIAL DAY NO MOD.	MAXFEE	WVR					52.65	1/1/2022	12/31/2299	N
MR122	COMMUNITY RESPITE PARTIAL DAY MA	MAXFEE	WVR					55.65	1/1/2022	12/31/2299	N
MR123	COMMUNITY RESPITE PARTIAL DAY BS	MAXFEE	WVR					68.40	1/1/2022	12/31/2299	N
MR124	COMMUNITY RESPITE PARTIAL DAY MABS	MAXFEE	WVR					71.40	1/1/2022	12/31/2299	N
MR125	COMMUNITY RESPITE 15 MINUTES NO MOD.	MAXFEE	WVR					2.11	1/1/2022	12/31/2299	N
MR126	COMMUNITY RESPITE 15 MINUTES MA	MAXFEE	WVR					2.23	1/1/2022	12/31/2299	N
MR127	COMMUNITY RESPITE 15 MINUTES BS	MAXFEE	WVR					2.74	1/1/2022	12/31/2299	N
MR128	COMMUNITY RESPITE 15 MINUTES MABS	MAXFEE	WVR					2.86	1/1/2022	12/31/2299	N
MR129	RESIDENTIAL RESPITE AGENCY DAY	MAXFEE	WVR					143.31	1/1/2022	12/31/2299	N
MR816	IOW HMKR PERS CARE-STAFF 2;15 MIN UNIT	MAXFEE	WVR					14.46	1/1/2022	12/31/2299	N
MR817	IOW HMKR PERS CARE-STAFF 3;15 MIN UNIT	MAXFEE	WVR					20.75	1/1/2022	12/31/2299	N
MR818	IOW HMKR PERS CARE-STAFF 4;15 MIN UNIT	MAXFEE	WVR					27.02	1/1/2022	12/31/2299	N
MR819	IOW HMKR PERS CARE-STAFF 5;15 MIN UNIT	MAXFEE	WVR					33.31	1/1/2022	12/31/2299	N
MR832	IOW HPC-OS/OC-STF 2; 15 MIN UNIT	MAXFEE	WVR					8.59	1/1/2022	12/31/2299	N
MR833	IOW HPC-OS/OC-STF 3; 15 MIN UNIT	MAXFEE	WVR					12.89	1/1/2022	12/31/2299	N
MR834	IOW HPC-OS/OC-STF 4; 15 MIN UNIT	MAXFEE	WVR					17.18	1/1/2022	12/31/2299	N
MR835	IOW HPC-OS/OC-STF 5; 15 MIN UNIT	MAXFEE	WVR					21.47	1/1/2022	12/31/2299	N
MR940	IOW HMKR PERS CARE; 15 MINUTE UNIT	MAXFEE	WVR					8.18	1/1/2022	12/31/2299	N
MR940	IOW HMKR PERS CARE; 15 MINUTE UNIT	MAXFEE	OVR					9.22	1/1/2022	12/31/2299	N
MR941	IOW TRANSPORTATION; 1 MILE UNIT	MAXFEE	OTH					1.04	1/1/2022	12/31/2299	N
MR941	IOW TRANSPORTATION; 1 MILE UNIT	MAXFEE	WVR					0.60	1/1/2022	12/31/2299	N
MR942	IOW SUPPORTED EMPLOY; 15 MINUTE UNIT	MAXFEE	WVR					NA			N
MR943	IOW INTERPRETER; 15 MINUTE UNIT	MAXFEE	WVR					13.46	7/1/2022	12/31/2299	N
MR944	IOW NUTRITIONAL; 15 MINUTE UNIT	MAXFEE	WVR					15.29	7/1/2022	12/31/2299	N
MR947	IOW SW/COUNSELING; 15 MINUTE UNIT	MAXFEE	WVR					13.29	7/1/2022	12/31/2299	N
MR948	IOW HOME DEL MEALS; 1 MEAL	MAXFEE	WVR					8.68	7/1/2022	12/31/2299	N
MR950	IOW ADAPT & ASSIST EQUIP; 1 ITEM	MAXFEE	WVR					10000	7/1/2005	12/31/2299	N
MR951	IOW HMKR PERS CARE-OS/OC; 15 MINUTE UNIT	MAXFEE	WVR					4.29	1/1/2022	12/31/2299	N
MR951	IOW HMKR PERS CARE-OS/OC; 15 MINUTE UNIT	MAXFEE	OVR					6.16	1/1/2022	12/31/2299	N