90965
CPT/HCPCSHome dialysis services per month (12-19 years)
Physician Fee Schedule
Facility
Medicare Payment
$379.57
Submitted Charge$1,738.25
Medicare Allowed$484.45
Providers69
Beneficiaries67
Total Services352
Office
Medicare Payment
$376.32
Submitted Charge$1,390.46
Medicare Allowed$479.82
Providers93
Beneficiaries97
Total Services521