90969
CPT/HCPCSDialysis services, per day, less than full month service (12-19 years)
Physician Fee Schedule
Facility
Medicare Payment
$12.70
Submitted Charge$62.75
Medicare Allowed$16.11
Providers35
Beneficiaries51
Total Services1,322
Office
Medicare Payment
$12.75
Submitted Charge$74.54
Medicare Allowed$15.91
Providers51
Beneficiaries54
Total Services1,241