| HCPCS | MOD1 | MOD2 | Ceiling | Floor | CT | DE | MA | ME | NH | NJ | NY | PA | RI | VT |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| E0450 | RR | $954.52 | $811.34 | $954.52 | $954.52 | $954.52 | $887.68 | $954.52 | $954.52 | $954.52 | $954.52 | $954.52 | $837.57 | |
| E0460 | RR | $733.57 | $623.53 | $733.57 | $623.53 | $623.53 | $623.53 | $623.53 | $623.53 | $623.53 | $623.53 | $623.53 | $623.53 | |
| E0461 | RR | $1002.05 | $851.74 | $1002.05 | $1002.05 | $1002.05 | $1002.05 | $1002.05 | $1002.05 | $1002.05 | $1002.05 | $1002.05 | $1002.05 | |
| E0463 | RR | $1406.38 | $1195.42 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | |
| E0464 | RR | $1406.38 | $1195.42 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | $1406.38 | |
| E0471 | RR | $642.17 | $545.84 | $642.17 | $545.84 | $642.17 | $642.17 | $642.17 | $545.84 | $642.17 | $545.84 | $642.17 | $642.17 | |
| E0472 | RR | $642.17 | $545.84 | $642.17 | $545.84 | $642.17 | $642.17 | $642.17 | $545.84 | $642.17 | $545.84 | $642.17 | $642.17 | |
| E0500 | RR | $109.77 | $93.30 | $107.03 | $103.33 | $109.77 | $109.77 | $109.77 | $109.77 | $109.77 | $104.07 | $109.77 | $109.77 | |
| E0575 | RR | $102.78 | $87.36 | $102.78 | $99.13 | $102.78 | $102.78 | $102.78 | $102.78 | $102.78 | $94.65 | $102.78 | $102.78 | |
| E0935 | RR | $22.73 | $19.32 | $22.73 | $22.73 | $22.73 | $22.73 | $22.73 | $22.73 | $19.32 | $22.73 | $19.32 | $22.73 | |
| K0455 | RR | $264.87 | $225.14 | $264.87 | $225.14 | $225.14 | $225.14 | $225.14 | $225.14 | $225.14 | $225.14 | $231.27 | $225.14 |