Q4205

CPT/HCPCS

Membrane graft or membrane wrap, per square centimeter

Physician Fee Schedule

Facility

Medicare Payment

$1,095.72

Submitted Charge$1,425.88
Medicare Allowed$1,375.24
Providers40
Beneficiaries106
Total Services5,402
Office

Medicare Payment

$1,135.61

Submitted Charge$1,564.46
Medicare Allowed$1,425.31
Providers822
Beneficiaries3,092
Total Services232,891.1