J3490
CPT/HCPCSUnclassified drugs
Physician Fee Schedule
Facility
Medicare Payment
$1,191.41
Submitted Charge$3,664.03
Medicare Allowed$1,495.35
Providers7
Beneficiaries22
Total Services31
Office
Medicare Payment
$217.02
Submitted Charge$626.02
Medicare Allowed$272.75
Providers10,270
Beneficiaries85,305
Total Services618,722.2