90964
CPT/HCPCSHome dialysis services per month (2-11 years)
Physician Fee Schedule
Facility
Medicare Payment
$397.89
Submitted Charge$1,797.16
Medicare Allowed$506.35
Providers75
Beneficiaries69
Total Services391
Office
Medicare Payment
$390.13
Submitted Charge$1,698.12
Medicare Allowed$493.80
Providers42
Beneficiaries46
Total Services255