90957
CPT/HCPCSDialysis services, 4 or more physician visits per month (12-19 years)
Physician Fee Schedule
Facility
Medicare Payment
$592.30
Submitted Charge$2,421.47
Medicare Allowed$751.52
Providers109
Beneficiaries131
Total Services648
Office
Medicare Payment
$572.91
Submitted Charge$2,042.72
Medicare Allowed$724.54
Providers162
Beneficiaries137
Total Services709