Q4133

CPT/HCPCS

Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter

Physician Fee Schedule

Facility

Medicare Payment

$105.99

Submitted Charge$253.69
Medicare Allowed$133.03
Providers16
Beneficiaries24
Total Services433
Office

Medicare Payment

$105.76

Submitted Charge$299.68
Medicare Allowed$132.84
Providers470
Beneficiaries978
Total Services80,081