Sample Letter of Appeal for Low Reimbursement of CPT 90734
payment for CPT®a 90734, Menactra® (Meningococcal [Groups A, C, Y and W-135] Polysaccharide Diphtheria Toxoid Conjugate Vaccine), given to my patient, [name], on [date of service]. For your reference, the average wholesale price (AWP) per dose of Menactra vaccine is $131.45.1 Our submitted charge for the vaccine was $ [provider’s charge], ................
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