Procedure Code,Procedure Description,Pricing Indicator,Rate Type,Mod1,Mod2,Mod3,Mod4,Max Fee,Max Fee Eff. Date,Max Fee End Date,PA,
="0001A",ADM SARSCOV2 30MCG/0.3ML 1ST,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0001A",ADM SARSCOV2 30MCG/0.3ML 1ST,MAXFEE,DEF,,,,,37.66,1/1/2022,12/31/2299,N,
="0002A",ADM SARSCOV2 30MCG/0.3ML 2ND,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0002A",ADM SARSCOV2 30MCG/0.3ML 2ND,MAXFEE,DEF,,,,,37.66,1/1/2022,12/31/2299,N,
="0003A",ADM SARSCOV2 30MCG/0.3ML 3RD,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0003A",ADM SARSCOV2 30MCG/0.3ML 3RD,MAXFEE,DEF,,,,,37.66,1/1/2022,12/31/2299,N,
="0004A",ADM SARSCOV2 30MCG/0.3ML BST,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0004A",ADM SARSCOV2 30MCG/0.3ML BST,MAXFEE,DEF,,,,,37.66,1/1/2022,12/31/2299,N,
="0011A",ADM SARSCOV2 100MCG/0.5ML1ST,OPXOVR,OPB,,,,,NA,NA,NA,N,
="0011A",ADM SARSCOV2 100MCG/0.5ML1ST,MAXFEE,DEF,,,,,37.66,1/1/2022,12/31/2299,N,
="0012A",ADM SARSCOV2 100MCG/0.5ML2ND,OPXOVR,OPB,,,,,NA,NA,NA,N,
="0012A",ADM SARSCOV2 100MCG/0.5ML2ND,MAXFEE,DEF,,,,,37.66,1/1/2022,12/31/2299,N,
="0013A",ADM SARSCOV2 100MCG/0.5ML3RD,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0013A",ADM SARSCOV2 100MCG/0.5ML3RD,MAXFEE,DEF,,,,,37.66,1/1/2022,12/31/2299,N,
="0051A",ADM SARSCV2 30MCG TRS-SUCR 1,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0051A",ADM SARSCV2 30MCG TRS-SUCR 1,MAXFEE,DEF,,,,,37.66,1/3/2022,12/31/2299,N,
="0052A",ADM SARSCV2 30MCG TRS-SUCR 2,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0052A",ADM SARSCV2 30MCG TRS-SUCR 2,MAXFEE,DEF,,,,,37.66,1/3/2022,12/31/2299,N,
="0053A",ADM SARSCV2 30MCG TRS-SUCR 3,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0053A",ADM SARSCV2 30MCG TRS-SUCR 3,MAXFEE,DEF,,,,,37.66,1/3/2022,12/31/2299,N,
="0054A",ADM SARSCV2 30MCG TRS-SUCR B,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0054A",ADM SARSCV2 30MCG TRS-SUCR B,MAXFEE,DEF,,,,,37.66,1/3/2022,12/31/2299,N,
="0064A",ADM SARSCOV2 50MCG/0.25MLBST,OPXOVR,OPB,,,,,NA,NA,NA,N,
="0064A",ADM SARSCOV2 50MCG/0.25MLBST,MAXFEE,DEF,,,,,37.66,1/1/2022,12/31/2299,N,
="0071A",ADM SARSCV2 10MCG TRS-SUCR 1,OPXOVR,OPB,,,,,NA,NA,NA,N,
="0071A",ADM SARSCV2 10MCG TRS-SUCR 1,MAXFEE,DEF,,,,,37.66,1/1/2022,12/31/2299,N,
="0072A",ADM SARSCV2 10MCG TRS-SUCR 2,OPXOVR,OPB,,,,,NA,NA,NA,N,
="0072A",ADM SARSCV2 10MCG TRS-SUCR 2,MAXFEE,DEF,,,,,37.66,1/1/2022,12/31/2299,N,
="0073A",ADM SARSCV2 10MCG TRS-SUCR 3,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0073A",ADM SARSCV2 10MCG TRS-SUCR 3,MAXFEE,DEF,,,,,37.66,1/3/2022,12/31/2299,N,
="0074A",ADM SARSCV2 10MCG TRS-SUCR B,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0074A",ADM SARSCV2 10MCG TRS-SUCR B,MAXFEE,DEF,,,,,37.66,5/17/2022,12/31/2299,N,
="0081A",ADM SARSCV2 3MCG TRS-SUCR 1,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0081A",ADM SARSCV2 3MCG TRS-SUCR 1,MAXFEE,DEF,,,,,37.66,6/17/2022,12/31/2299,N,
="0082A",ADM SARSCV2 3MCG TRS-SUCR 2,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0082A",ADM SARSCV2 3MCG TRS-SUCR 2,MAXFEE,DEF,,,,,37.66,6/17/2022,12/31/2299,N,
="0083A",ADM SARSCV2 3MCG TRS-SUCR 3,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0083A",ADM SARSCV2 3MCG TRS-SUCR 3,MAXFEE,DEF,,,,,37.66,6/17/2022,12/31/2299,N,
="0091A",ADM SARSCOV2 50 MCG/.5 ML1ST,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0091A",ADM SARSCOV2 50 MCG/.5 ML1ST,MAXFEE,DEF,,,,,37.66,6/17/2022,12/31/2299,N,
="0092A",ADM SARSCOV2 50 MCG/.5 ML2ND,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0092A",ADM SARSCOV2 50 MCG/.5 ML2ND,MAXFEE,DEF,,,,,37.66,6/17/2022,12/31/2299,N,
="0093A",ADM SARSCOV2 50 MCG/.5 ML3RD,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0093A",ADM SARSCOV2 50 MCG/.5 ML3RD,MAXFEE,DEF,,,,,37.66,6/17/2022,12/31/2299,N,
="0094A",ADM SARSCOV2 50 MCG/.5 MLBST,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0094A",ADM SARSCOV2 50 MCG/.5 MLBST,MAXFEE,DEF,,,,,37.66,3/29/2022,12/31/2299,N,
="0111A",ADM SARSCOV2 25MCG/0.25ML1ST,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0111A",ADM SARSCOV2 25MCG/0.25ML1ST,MAXFEE,DEF,,,,,37.66,6/17/2022,12/31/2299,N,
="0112A",ADM SARSCOV2 25MCG/0.25ML2ND,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0112A",ADM SARSCOV2 25MCG/0.25ML2ND,MAXFEE,DEF,,,,,37.66,6/17/2022,12/31/2299,N,
="0113A",ADM SARSCOV2 25MCG/0.25ML3RD,OPXOVR,DEF,,,,,NA,NA,NA,N,
="0113A",ADM SARSCOV2 25MCG/0.25ML3RD,MAXFEE,DEF,,,,,37.66,8/31/2022,12/31/2299,N,
="90460",IM ADMIN 1ST/ONLY COMPONENT,OPXOVR,DEF,,,,,NA,NA,NA,N,
="90460",IM ADMIN 1ST/ONLY COMPONENT,MAXFEE,DEF,,,,,15,1/1/2016,12/31/2299,N,
="90461",IM ADMIN EACH ADDL COMPONENT,OPXOVR,DEF,,,,,NA,NA,NA,N,
="90461",IM ADMIN EACH ADDL COMPONENT,MAXFEE,DEF,,,,,0,1/1/2011,12/31/2299,N,
="90471",IMMUNIZATION ADMIN,OPXOVR,DEF,,,,,NA,NA,NA,N,
="90471",IMMUNIZATION ADMIN,MAXFEE,DEF,,,,,12.95,1/1/2022,12/31/2299,N,
="90472",IMMUNIZATION ADMIN EACH ADD,OPXOVR,DEF,,,,,NA,NA,NA,N,
="90472",IMMUNIZATION ADMIN EACH ADD,MAXFEE,DEF,,,,,9.85,1/1/2022,12/31/2299,N,
="90480",ADMN SARSCOV2 VACC 1 DOSE,OPXOVR,OPB,,,,,NA,NA,NA,N,
="90480",ADMN SARSCOV2 VACC 1 DOSE,MAXFEE,DEF,,,,,39.94,9/11/2023,12/31/2299,N,
="90611",SMALLPOX&MONKEYPOX VAC 0.5ML,OPXOVR,DEF,,,,,NA,NA,NA,N,
="90611",SMALLPOX&MONKEYPOX VAC 0.5ML,MAXFEE,DEF,,,,,0.01,7/26/2022,12/31/2299,N,
="90622",VACCINIA VRS VAC 0.3 ML PERQ,OPXOVR,DEF,,,,,NA,NA,NA,N,
="90622",VACCINIA VRS VAC 0.3 ML PERQ,MAXFEE,DEF,,,,,0.01,7/26/2022,12/31/2299,N,
="91300",SARSCOV2 VAC 30MCG/0.3ML IM,OPXOVR,DEF,,,,,NA,NA,NA,N,
="91300",SARSCOV2 VAC 30MCG/0.3ML IM,MAXFEE,DEF,,,,,0.01,12/11/2020,12/31/2299,N,
="91301",SARSCOV2 VAC 100MCG/0.5ML IM,OPXOVR,DEF,,,,,NA,NA,NA,N,
="91301",SARSCOV2 VAC 100MCG/0.5ML IM,MAXFEE,DEF,,,,,0.01,12/18/2020,12/31/2299,N,
="91304",SARSCOV2 VAC 5MCG/0.5ML IM,OPXOVR,DEF,,,,,NA,NA,NA,N,
="91304",SARSCOV2 VAC 5MCG/0.5ML IM,MAXFEE,DEF,,,,,148.20,10/1/2023,12/31/2299,N,
="91305",SARSCOV2 VAC 30 MCG TRS-SUCR,OPXOVR,DEF,,,,,NA,NA,NA,N,
="91305",SARSCOV2 VAC 30 MCG TRS-SUCR,MAXFEE,DEF,,,,,0.01,1/3/2022,12/31/2299,N,
="91306",SARSCOV2 VAC 50MCG/0.25ML IM,OPXOVR,OPB,,,,,NA,NA,NA,N,
="91306",SARSCOV2 VAC 50MCG/0.25ML IM,MAXFEE,DEF,,,,,0.01,10/20/2021,12/31/2299,N,
="91307",SARSCOV2 VAC 10 MCG TRS-SUCR,OPXOVR,OPB,,,,,NA,NA,NA,N,
="91307",SARSCOV2 VAC 10 MCG TRS-SUCR,MAXFEE,DEF,,,,,0.01,10/29/2021,12/31/2299,N,
="91308",SARSCOV2 VAC 3 MCG TRS-SUCR,OPXOVR,DEF,,,,,NA,NA,NA,N,
="91308",SARSCOV2 VAC 3 MCG TRS-SUCR,MAXFEE,DEF,,,,,0.01,6/17/2022,12/31/2299,N,
="91309",SARSCOV2 VAC 50MCG/0.5ML IM,OPXOVR,DEF,,,,,NA,NA,NA,N,
="91309",SARSCOV2 VAC 50MCG/0.5ML IM,MAXFEE,DEF,,,,,0.01,3/29/2022,12/31/2299,N,
="91311",SARSCOV2 VAC 25MCG/0.25ML IM,OPXOVR,DEF,,,,,NA,NA,NA,N,
="91311",SARSCOV2 VAC 25MCG/0.25ML IM,MAXFEE,DEF,,,,,0.01,6/17/2022,12/31/2299,N,
="91318",SARSCOV2 VAC 3MCG TRS-SUC IM,OPXOVR,OPB,,,,,NA,NA,NA,N,
="91318",SARSCOV2 VAC 3MCG TRS-SUC IM,MAXFEE,DEF,,,,,65.55,1/1/2024,12/31/2299,N,
="91319",SARSCV2 VAC 10MCG TRS-SUC IM,OPXOVR,OPB,,,,,NA,NA,NA,N,
="91319",SARSCV2 VAC 10MCG TRS-SUC IM,MAXFEE,DEF,,,,,87.78,10/1/2023,12/31/2299,N,
="91320",SARSCV2 VAC 30MCG TRS-SUC IM,OPXOVR,OPB,,,,,NA,NA,NA,N,
="91320",SARSCV2 VAC 30MCG TRS-SUC IM,MAXFEE,DEF,,,,,131.10,10/1/2023,12/31/2299,N,
="91321",SARSCOV2 VAC 25 MCG/.25ML IM,OPXOVR,OPB,,,,,NA,NA,NA,N,
="91321",SARSCOV2 VAC 25 MCG/.25ML IM,MAXFEE,DEF,,,,,145.92,10/1/2023,12/31/2299,N,
="91322",SARSCOV2 VAC 50 MCG/0.5ML IM,OPXOVR,OPB,,,,,NA,NA,NA,N,
="91322",SARSCOV2 VAC 50 MCG/0.5ML IM,MAXFEE,DEF,,,,,145.92,10/1/2023,12/31/2299,N,
="96101",PSYCHO TESTING BY PSYCH/PHYS,MAXFEE,OPB,,,,,NA,,,S,
="96101",PSYCHO TESTING BY PSYCH/PHYS,OPXOVR,OPB,,,,,NA,NA,NA,S,
="96111",DEVELOPMENTAL TEST EXTEND,MAXFEE,OPB,,,,,NA,,,S,
="96111",DEVELOPMENTAL TEST EXTEND,OPXOVR,OPB,,,,,NA,NA,NA,S,
="96118",NEUROPSYCH TST BY PSYCH/PHYS,MAXFEE,OPB,,,,,NA,,,S,
="96118",NEUROPSYCH TST BY PSYCH/PHYS,OPXOVR,OPB,,,,,NA,NA,NA,S,
="99201",OFFICE/OUTPATIENT VISIT NEW,MAXFEE,OPB,,,,,49.38,8/1/2017,12/31/2299,N,
="99201",OFFICE/OUTPATIENT VISIT NEW,OPXOVR,OPB,,,,,NA,NA,NA,N,
="99343",HOME VISIT NEW PATIENT,MAXFEE,OPB,,,,,NA,,,N,
="99343",HOME VISIT NEW PATIENT,OPXOVR,OPB,,,,,NA,NA,NA,N,
="99354",PROLNG SVC O/P 1ST HOUR,MAXFEE,OPB,,,,,NA,,,N,
="99354",PROLNG SVC O/P 1ST HOUR,OPXOVR,OPB,,,,,NA,NA,NA,N,
="99355",PROLNG SVC O/P EA ADDL 30,MAXFEE,OPB,,,,,NA,,,N,
="99355",PROLNG SVC O/P EA ADDL 30,OPXOVR,OPB,,,,,NA,NA,NA,N,
="G0312",IMMUNIZE COUNS < 21YR 5-15 M,OPXOVR,DEF,,,,,NA,NA,NA,N,
="G0312",IMMUNIZE COUNS < 21YR 5-15 M,MAXFEE,DEF,,,,,26.21,6/8/2022,12/31/2299,N,
="G0313",IMMUNIZE COUNS < 21YR 6-30 M,OPXOVR,DEF,,,,,NA,NA,NA,N,
="G0313",IMMUNIZE COUNS < 21YR 6-30 M,MAXFEE,DEF,,,,,39.90,6/8/2022,12/31/2299,N,
="G0378",HOSPITAL OBSERVATION PER HR,MAXFEE,OPB,,,,,NA,,,N,
="G0378",HOSPITAL OBSERVATION PER HR,OPXOVR,OPB,,,,,NA,NA,NA,N,
="J3399",INJ ONASE ABEPAR-XIOI TREAT,PRXOVR,DEF,,,,,NA,NA,NA,E,
="J3399",INJ ONASE ABEPAR-XIOI TREAT,MANUAL,DEF,,,,,NA,NA,NA,E,
="J3490",DRUGS UNCLASSIFIED INJECTION,PRXOVR,DEF,,,,,NA,NA,NA,Y,
="J3490",DRUGS UNCLASSIFIED INJECTION,MANUAL,DEF,,,,,NA,NA,NA,Y,