90958
CPT/HCPCSDialysis services, 2-3 physician visits per month (12-19 years)
Physician Fee Schedule
Facility
Medicare Payment
$388.63
Submitted Charge$1,688.69
Medicare Allowed$496.54
Providers61
Beneficiaries67
Total Services156
Office
Medicare Payment
$378.04
Submitted Charge$1,082.99
Medicare Allowed$475.78
Providers91
Beneficiaries82
Total Services194