90959
CPT/HCPCSDialysis services, 1 physician visit per month (12-19 years)
Physician Fee Schedule
Facility
Medicare Payment
$252.88
Submitted Charge$1,257.40
Medicare Allowed$320.97
Providers36
Beneficiaries44
Total Services121
Office
Medicare Payment
$251.11
Submitted Charge$884.21
Medicare Allowed$314.37
Providers45
Beneficiaries43
Total Services104