| H2015 | Comprehensive community support services, per 15 minutes | 52 | 120 | 2,640 | $150 | $1.2M |
| D0999 | N/A | 6 | 80 | 2,250 | $190 | $987.3K |
| H2014 | Skills training and development, per 15 minutes | 5 | 10 | 4,350 | $120 | $740.4K |
| Q3014 | Telehealth originating site facility fee | 157 | 180 | 620 | $160 | $546.7K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 26 | 930 | 910 | $80 | $521.6K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 95 | 960 | 1,010 | $90 | $490K |
| 99391 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 34 | 100 | 1,100 | $110 | $362K |
| 90837 | In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or… | 155 | 920 | 860 | $120 | $361.9K |
| 99392 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 35 | 120 | 670 | $110 | $301.2K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 28 | 380 | 220 | $160 | $273.9K |