Q4221

CPT/HCPCS

Amniowrap2, per square centimeter

Physician Fee Schedule

Facility

Medicare Payment

$992.65

Submitted Charge$1,272.68
Medicare Allowed$1,246.02
Providers15
Beneficiaries47
Total Services1,932
Office

Medicare Payment

$1,121.32

Submitted Charge$1,535.33
Medicare Allowed$1,407.57
Providers80
Beneficiaries327
Total Services17,392