| Procedure Code | Procedure Description | Pricing Indicator | Rate Type | Mod1 | Mod2 | Mod3 | Mod4 | Max Fee | Max Fee Eff. Date | Max Fee End Date | PA |
| S5125 | ATTENDANT CARE SERVICE /15M | HHPDN | OAB | NA | NA | NA | N | ||||
| S5125 | ATTENDANT CARE SERVICE /15M | HHPDN | BS2 | NA | NA | NA | N | ||||
| S5125 | ATTENDANT CARE SERVICE /15M | MAXFEE | OAU | 6.60 | 11/1/2021 | 12/31/2299 | N | ||||
| S5125 | ATTENDANT CARE SERVICE /15M | MAXFEE | DEF | 3.24 | 11/1/2021 | 12/31/2299 | N | ||||
| S5125 | ATTENDANT CARE SERVICE /15M | MAXFEE | OU8 | 4.56 | 11/1/2021 | 12/31/2299 | N |