| T2022 | Case management, per month | 6 | 40 | 800 | $190 | $780.3K |
| H0047 | Alcohol and/or other drug abuse services, not otherwise specified | 2 | 30 | 750 | $240 | $312.9K |
| 99408 | The provider spends 15 to 30 minutes screening a patient for abuse of alcohol or another non–tobacco substance. The provider then performs a brief intervention at the same session. | 2 | 30 | 740 | $240 | $301.1K |
| T1041 | Medicaid certified community behavioral health clinic services, per month | 1 | 10 | 440 | $390 | $226K |
| 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… | 166 | 460 | 1,240 | $30 | $190K |
| T1007 | Alcohol and/or substance abuse services, treatment plan development and/or modification | 1 | 10 | 440 | $250 | $142.1K |
| 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… | 301 | 480 | 1,030 | $20 | $128.9K |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 32 | 40 | 1,260 | $20 | $96.8K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 28 | 40 | 2,130 | $20 | $89.9K |
| 99204 | The provider sees a new 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 provider… | 129 | 150 | 150 | $60 | $37.6K |