Active NPI 1548281116
Individual Practitioner
Male Practitioner
Dr. Patrick Andrew Gustine , MD
Radiology - Diagnostic Radiology • Toledo, OH
✓ Accepts Medicare Assignment
Public Directory Information & Medical Disclaimer
This profile is compiled from official public domain records provided by CMS and the NPPES registry. TRUE-MEDINFO is an independent reference directory and does not provide medical advice, diagnosis, or treatment recommendations. Always consult a licensed medical professional for personal health decisions.
Professional Overview & Biography Verified Profile Summary
Dr. Patrick Gustine, MD is a registered Radiology - Diagnostic Radiology practitioner in Toledo, OH. With approximately 31 years of clinical practice since graduating from University Of Michigan Medical School in 1995, Dr. Gustine provides healthcare services at the registered practice location at 3900 SUNFOREST CT STE 136.
Dr. Gustine is affiliated with Toledo Clinic Incorporated and accepts Medicare assignment.
Frequently performed procedures and clinical services include injection, gadoterate meglumine, 0.1 ml, low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml, injection, methylprednisolone acetate, 1 mg. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.
Practice Location & Contact Primary Location
Practice Address
3900 Sunforest Ct Ste 136
Toledo, OH 436234440
Telephone
4194741104
Fax
4194732867
Associated Practice Facility / Clinic
🏢
Jennifer L Zoll, Dds, Llc
Facility NPI 1609262443
Medicare Profile & Education
Medical School
University Of Michigan Medical School
Graduation Year
1995
Medicare Assignment
✓ Accepts Assignment
Telehealth Flag
In-Person Only
Specialty Benchmarks & Practice Insights
Comparative analytics for Radiology - Diagnostic Radiology in Toledo, OH
Practitioner Clinical Experience
31 Yrs
+6.3 yrs vs City Avg
City Avg: 24.7 Yrs
State Avg: 30.3 Yrs
Regional Practice Density
81
Specialists
Practicing in Toledo, OH (1658 Statewide)
Telehealth Adoption Rate
0.0%
Regional Adoption
In-Person Office Visits Only
Medicare Pricing Discount
62.6%
Avg Savings
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Clinical Seniority & Experience Comparison
Dr. Gustine (31 Years)
31 Yrs
Toledo Specialty Average (24.7 Years)
24.7 Yrs
Performed Procedures & Service Volume
Top Medicare Part B procedures performed by this practitioner
CMS Official Data (2024)
Reporting Year:
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
A9575
Injection, gadoterate meglumine, 0.1 ml
|
39,250 | 223 | $1.00 | $0.12 |
|
Q9967
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
|
32,686 | 331 | $2.00 | $0.13 |
|
J1010
Injection, methylprednisolone acetate, 1 mg
|
880 | 11 | $0.31 | $0.12 |
|
77063
Screening digital tomography of both breasts
|
570 | 570 | $107.00 | $47.52 |
|
77067
Screening mammography
|
570 | 570 | $203.00 | $114.70 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
294 | 293 | $118.81 | $35.21 |
|
71046
X-ray of chest, 2 views
|
283 | 278 | $57.60 | $30.08 |
|
71250
Ct scan of chest without contrast
|
220 | 206 | $309.00 | $117.68 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
181 | 162 | $584.33 | $266.50 |
|
71260
Ct scan of chest with contrast
|
174 | 154 | $432.00 | $112.99 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
156 | 151 | $64.59 | $35.64 |
|
76705
Limited ultrasound scan of abdomen
|
143 | 140 | $208.00 | $79.47 |
|
74018
X-ray of abdomen, 1 view
|
134 | 128 | $52.00 | $27.45 |
|
73630
X-ray of foot, minimum of 3 views
|
128 | 115 | $63.13 | $36.07 |
|
A9608
Flotufolastat f 18, diagnostic, 1 millicurie
|
123 | 15 | $2853.12 | $590.17 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
123 | 118 | $2120.00 | $1066.24 |
|
A9595
Piflufolastat f-18, diagnostic, 1 millicurie
|
119 | 13 | $1992.77 | $559.04 |
|
73030
X-ray of shoulder, minimum of 2 views
|
113 | 111 | $61.89 | $36.30 |
|
A9552
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
|
110 | 103 | $1022.36 | $144.09 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
102 | 102 | $136.00 | $54.50 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
101 | 97 | $382.00 | $164.29 |
|
73562
X-ray of knee, 3 views
|
88 | 82 | $81.02 | $44.97 |
|
76770
Complete ultrasound scan behind abdominal cavity
|
84 | 84 | $216.00 | $96.22 |
|
70553
Mri scan of brain before and after contrast
|
82 | 81 | $795.00 | $293.66 |
|
72148
MRI scan of lower spinal canal
|
80 | 80 | $522.00 | $173.56 |
|
76536
Ultrasound of head and neck
|
75 | 73 | $220.00 | $100.43 |
|
73502
X-ray of hip, 2-3 views
|
73 | 72 | $74.93 | $41.53 |
|
72040
X-ray of upper spine, 2-3 views
|
66 | 66 | $62.38 | $35.79 |
|
A9503
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
|
59 | 55 | $100.12 | $24.19 |
|
72197
Mri scan of pelvis before and after contrast
|
56 | 54 | $949.00 | $308.18 |
|
78306
Nuclear medicine study of bone and/or joint whole body
|
55 | 51 | $489.00 | $236.69 |
|
76981
Elastography ultrasound of organ tissue
|
53 | 53 | $205.00 | $94.62 |
|
71271
Low dose ct scan of chest for lung cancer screening
|
53 | 53 | $292.00 | $127.23 |
|
73130
X-ray of hand, minimum of 3 views
|
48 | 47 | $72.50 | $43.06 |
|
73610
X-ray of ankle, minimum of 3 views
|
46 | 38 | $63.41 | $36.43 |
|
73564
X-ray of knee, 4 or more views
|
46 | 46 | $88.30 | $51.21 |
|
77077
X-ray of joints, multiple
|
44 | 44 | $89.00 | $43.05 |
|
Q9966
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml
|
43 | 13 | $5.00 | $0.38 |
|
76377
3D radiographic procedure with computerized image postprocessing
|
43 | 42 | $137.00 | $72.22 |
|
74183
Mri scan of abdomen before and after contrast
|
42 | 42 | $950.00 | $317.47 |
|
72202
X-ray of joint between lower spine and hip bone, 3 or more views
|
41 | 41 | $62.00 | $35.92 |
|
72072
X-ray of middle spine, 3 views
|
37 | 37 | $65.00 | $36.23 |
|
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
|
33 | 33 | $107.00 | $44.17 |
|
74178
Ct scan of abdomen and pelvis before and after contrast
|
32 | 32 | $665.00 | $309.54 |
|
70491
CT scan of neck with contrast
|
31 | 28 | $444.00 | $147.20 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
31 | 31 | $92.00 | $47.41 |
|
77065
Diagnostic mammography of 1 breast
|
28 | 28 | $227.00 | $114.72 |
|
73721
Mri scan of leg joint without contrast
|
27 | 27 | $581.78 | $176.13 |
|
72120
X-ray lower and sacral spine including bending views 2 or 3 views
|
25 | 25 | $76.00 | $36.01 |
|
73560
X-ray of knee, 1-2 views
|
25 | 25 | $112.24 | $58.58 |
|
76642
Limited ultrasound scan of 1 breast
|
25 | 25 | $175.76 | $77.27 |
|
72170
X-ray of pelvis, 1-2 views
|
24 | 24 | $58.21 | $24.00 |
|
73620
X-ray of foot, 2 views
|
24 | 24 | $95.96 | $51.25 |
|
72141
MRI scan of upper spinal canal
|
23 | 23 | $525.00 | $166.79 |
|
74019
X-ray of abdomen, 2 views
|
23 | 23 | $63.00 | $33.47 |
|
73110
X-ray of wrist, minimum of 3 views
|
22 | 20 | $72.77 | $39.99 |
|
72146
Mri scan of middle spinal canal
|
22 | 22 | $529.00 | $139.03 |
|
72070
X-ray of middle spine, 2 views
|
21 | 19 | $64.00 | $30.16 |
|
71275
Ct scan of blood vessels of chest with contrast
|
20 | 20 | $566.00 | $226.56 |
|
71045
X-ray of chest, 1 view
|
20 | 20 | $45.20 | $17.35 |
|
93971
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
|
19 | 18 | $228.00 | $103.69 |
|
73522
X-ray of both hips, 3-4 views
|
19 | 19 | $85.47 | $45.49 |
|
70551
Mri scan of brain without contrast
|
19 | 19 | $585.00 | $178.55 |
|
71100
X-ray of ribs of one side of body, 2 views
|
18 | 18 | $59.78 | $32.17 |
|
78816
Nuclear medicine study whole body with ct scan
|
18 | 16 | $2151.00 | $1075.49 |
|
77049
Mri of both breasts with and without contrast
|
18 | 18 | $768.00 | $321.94 |
|
72158
Mri scan of lower spinal canal before and after contrast
|
17 | 17 | $782.00 | $259.40 |
|
76882
Limited ultrasound scan of joint or other extremity structure except blood vessels
|
17 | 17 | $101.00 | $58.94 |
|
73221
Mri scan of arm joint without contrast
|
16 | 16 | $583.31 | $202.09 |
|
76870
Ultrasound scan of scrotum
|
14 | 14 | $192.00 | $91.44 |
|
70450
Ct scan head or brain without contrast
|
14 | 14 | $347.00 | $92.64 |
|
77074
X-ray of bones
|
14 | 14 | $122.00 | $59.84 |
|
73080
X-ray of elbow, minimum of 3 views
|
13 | 13 | $62.46 | $30.65 |
|
73523
X-ray of both hips, minimum of 5 views
|
12 | 12 | $107.00 | $56.49 |
|
72128
CT scan of middle spine
|
12 | 11 | $307.00 | $118.33 |
|
93880
Ultrasound of both sides of head and neck blood flow
|
12 | 12 | $361.00 | $172.34 |
|
20610
Aspiration and/or injection of fluid from large joint
|
12 | 12 | $118.00 | $61.23 |
|
77002
Fluoroscopic guidance for needle placement
|
12 | 12 | $220.00 | $105.43 |
|
72131
CT scan of lower spine
|
12 | 12 | $307.00 | $87.57 |
|
70486
CT scan of face
|
12 | 12 | $304.00 | $115.91 |
|
76856
Complete ultrasound scan of pelvis
|
11 | 11 | $209.00 | $93.44 |
|
71270
Ct scan of chest before and after contrast
|
11 | 11 | $517.00 | $152.88 |
|
70480
Ct scan of cranial cavity without contrast
|
11 | 11 | $367.00 | $149.56 |
|
70498
Ct scan of blood vessels of neck with contrast
|
11 | 11 | $695.00 | $231.01 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
A9575
Injection, gadoterate meglumine, 0.1 ml
|
41,050 | 228 | $1.00 | $0.14 |
|
Q9967
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
|
34,545 | 347 | $1.80 | $0.15 |
|
77067
Screening mammography
|
489 | 489 | $203.00 | $117.86 |
|
77063
Screening digital tomography of both breasts
|
488 | 488 | $107.00 | $49.29 |
|
71046
X-ray of chest, 2 views
|
260 | 250 | $57.63 | $30.78 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
212 | 195 | $583.24 | $285.07 |
|
71250
Ct scan of chest without contrast
|
197 | 185 | $309.00 | $121.29 |
|
71260
Ct scan of chest with contrast
|
168 | 152 | $432.00 | $115.72 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
166 | 163 | $136.00 | $54.22 |
|
A9595
Piflufolastat f-18, diagnostic, 1 millicurie
|
165 | 17 | $4960.76 | $499.55 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
162 | 162 | $119.00 | $35.21 |
|
76705
Limited ultrasound scan of abdomen
|
145 | 142 | $208.00 | $81.33 |
|
74018
X-ray of abdomen, 1 view
|
145 | 130 | $51.90 | $28.04 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
136 | 130 | $2120.00 | $1078.03 |
|
A9552
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
|
135 | 126 | $943.78 | $163.50 |
|
73630
X-ray of foot, minimum of 3 views
|
122 | 113 | $60.64 | $36.06 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
114 | 113 | $63.30 | $35.48 |
|
73030
X-ray of shoulder, minimum of 2 views
|
103 | 101 | $56.89 | $34.03 |
|
A9503
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
|
94 | 77 | $86.86 | $24.05 |
|
73562
X-ray of knee, 3 views
|
92 | 86 | $78.13 | $44.30 |
|
78306
Nuclear medicine study of bone and/or joint whole body
|
90 | 73 | $487.29 | $248.01 |
|
70553
Mri scan of brain before and after contrast
|
87 | 82 | $795.00 | $292.80 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
81 | 78 | $382.00 | $175.73 |
|
76536
Ultrasound of head and neck
|
77 | 77 | $220.00 | $103.76 |
|
73502
X-ray of hip, 2-3 views
|
64 | 64 | $74.50 | $41.24 |
|
73130
X-ray of hand, minimum of 3 views
|
59 | 57 | $69.39 | $41.76 |
|
72148
MRI scan of lower spinal canal
|
57 | 57 | $522.00 | $180.52 |
|
71271
Low dose ct scan of chest for lung cancer screening
|
57 | 57 | $292.00 | $132.06 |
|
72197
Mri scan of pelvis before and after contrast
|
51 | 49 | $949.00 | $319.67 |
|
72040
X-ray of upper spine, 2-3 views
|
48 | 48 | $62.15 | $35.94 |
|
74183
Mri scan of abdomen before and after contrast
|
45 | 41 | $950.00 | $324.79 |
|
72072
X-ray of middle spine, 3 views
|
43 | 42 | $64.00 | $36.08 |
|
73610
X-ray of ankle, minimum of 3 views
|
42 | 39 | $59.62 | $35.17 |
|
73564
X-ray of knee, 4 or more views
|
40 | 38 | $73.95 | $41.19 |
|
76377
3D radiographic procedure with computerized image postprocessing
|
40 | 40 | $133.58 | $68.94 |
|
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
|
36 | 36 | $107.00 | $50.08 |
|
73110
X-ray of wrist, minimum of 3 views
|
35 | 34 | $72.83 | $42.06 |
|
76770
Complete ultrasound scan behind abdominal cavity
|
33 | 33 | $216.00 | $100.86 |
|
74178
Ct scan of abdomen and pelvis before and after contrast
|
33 | 33 | $665.00 | $322.69 |
|
72141
MRI scan of upper spinal canal
|
28 | 28 | $525.00 | $170.02 |
|
74019
X-ray of abdomen, 2 views
|
28 | 27 | $63.00 | $33.67 |
|
77065
Diagnostic mammography of 1 breast
|
27 | 25 | $227.00 | $117.25 |
|
77077
X-ray of joints, multiple
|
27 | 27 | $81.00 | $44.02 |
|
76642
Limited ultrasound scan of 1 breast
|
26 | 25 | $195.00 | $86.41 |
|
70491
CT scan of neck with contrast
|
25 | 24 | $444.00 | $140.20 |
|
78816
Nuclear medicine study whole body with ct scan
|
25 | 22 | $2151.00 | $1078.46 |
|
72158
Mri scan of lower spinal canal before and after contrast
|
25 | 25 | $782.00 | $302.83 |
|
72120
X-ray lower and sacral spine including bending views 2 or 3 views
|
24 | 24 | $76.00 | $37.89 |
|
73721
Mri scan of leg joint without contrast
|
21 | 21 | $561.00 | $188.18 |
|
72170
X-ray of pelvis, 1-2 views
|
21 | 21 | $60.00 | $26.16 |
|
93880
Ultrasound of both sides of head and neck blood flow
|
20 | 20 | $361.00 | $177.49 |
|
72202
X-ray of joint between lower spine and hip bone, 3 or more views
|
20 | 20 | $62.00 | $36.69 |
|
70551
Mri scan of brain without contrast
|
20 | 20 | $585.00 | $187.71 |
|
76882
Limited ultrasound scan of joint or other extremity structure except blood vessels
|
20 | 20 | $101.00 | $40.71 |
|
70450
Ct scan head or brain without contrast
|
19 | 19 | $347.00 | $94.55 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
19 | 19 | $92.00 | $47.69 |
|
78264
Stomach emptying study
|
18 | 18 | $646.00 | $283.31 |
|
76981
Elastography ultrasound of organ tissue
|
18 | 17 | $205.00 | $97.17 |
|
72070
X-ray of middle spine, 2 views
|
18 | 18 | $64.00 | $30.85 |
|
71275
Ct scan of blood vessels of chest with contrast
|
18 | 18 | $566.00 | $245.93 |
|
71045
X-ray of chest, 1 view
|
18 | 18 | $47.94 | $18.18 |
|
A9541
Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries
|
18 | 18 | $335.00 | $59.98 |
|
93971
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
|
17 | 17 | $228.00 | $105.67 |
|
73523
X-ray of both hips, minimum of 5 views
|
17 | 17 | $98.18 | $49.76 |
|
73221
Mri scan of arm joint without contrast
|
17 | 17 | $549.00 | $188.57 |
|
73080
X-ray of elbow, minimum of 3 views
|
17 | 17 | $58.00 | $30.41 |
|
77066
Diagnostic mammography of both breasts
|
17 | 17 | $440.00 | $147.72 |
|
73700
Ct scan of leg without contrast
|
15 | 15 | $347.93 | $136.38 |
|
72146
Mri scan of middle spinal canal
|
14 | 14 | $529.00 | $154.67 |
|
71100
X-ray of ribs of one side of body, 2 views
|
14 | 14 | $62.00 | $34.50 |
|
73560
X-ray of knee, 1-2 views
|
14 | 14 | $104.57 | $54.74 |
|
70486
CT scan of face
|
13 | 13 | $304.00 | $108.59 |
|
A9537
Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries
|
13 | 13 | $150.00 | $57.98 |
|
78226
Imaging of liver and bile duct system
|
13 | 13 | $640.00 | $260.74 |
|
76856
Complete ultrasound scan of pelvis
|
12 | 12 | $209.00 | $99.27 |
|
77049
Mri of both breasts with and without contrast
|
12 | 12 | $768.00 | $334.80 |
|
74174
Ct scan of blood vessels of abdomen and pelvis with contrast
|
12 | 11 | $732.00 | $368.21 |
|
76830
Ultrasound pelvis through vagina
|
12 | 12 | $232.00 | $112.26 |
|
77012
Review by radiologist of ct guidance for needle placement
|
11 | 11 | $239.00 | $133.89 |
|
73522
X-ray of both hips, 3-4 views
|
11 | 11 | $92.00 | $50.06 |
|
76870
Ultrasound scan of scrotum
|
11 | 11 | $178.18 | $91.73 |
|
93970
Ultrasound study of arm or leg veins with compression and maneuvers
|
11 | 11 | $351.91 | $160.32 |
|
77002
Fluoroscopic guidance for needle placement
|
11 | 11 | $196.00 | $108.43 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
A9575
Injection, gadoterate meglumine, 0.1 ml
|
36,418 | 212 | $1.01 | $0.14 |
|
Q9967
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
|
25,546 | 285 | $1.07 | $0.11 |
|
77063
Screening digital tomography of both breasts
|
358 | 358 | $107.00 | $50.26 |
|
77067
Screening mammography
|
358 | 358 | $203.00 | $120.98 |
|
71046
X-ray of chest, 2 views
|
304 | 287 | $57.47 | $31.18 |
|
71250
Ct scan of chest without contrast
|
182 | 173 | $309.00 | $124.75 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
173 | 171 | $136.00 | $54.57 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
167 | 153 | $586.00 | $301.67 |
|
71260
Ct scan of chest with contrast
|
142 | 125 | $432.00 | $120.28 |
|
76705
Limited ultrasound scan of abdomen
|
134 | 133 | $207.46 | $83.56 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
131 | 128 | $64.15 | $36.70 |
|
74018
X-ray of abdomen, 1 view
|
127 | 118 | $52.00 | $28.38 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
114 | 114 | $119.00 | $34.88 |
|
73630
X-ray of foot, minimum of 3 views
|
99 | 89 | $56.21 | $33.41 |
|
73030
X-ray of shoulder, minimum of 2 views
|
94 | 92 | $58.49 | $34.96 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
89 | 85 | $2120.00 | $1086.55 |
|
A9552
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
|
87 | 81 | $871.00 | $175.05 |
|
70553
Mri scan of brain before and after contrast
|
83 | 81 | $795.00 | $309.13 |
|
73562
X-ray of knee, 3 views
|
79 | 77 | $80.57 | $46.41 |
|
72148
MRI scan of lower spinal canal
|
75 | 74 | $517.03 | $187.15 |
|
73502
X-ray of hip, 2-3 views
|
75 | 75 | $77.25 | $44.13 |
|
76536
Ultrasound of head and neck
|
71 | 70 | $222.13 | $105.00 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
65 | 62 | $389.39 | $180.90 |
|
A9503
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
|
63 | 56 | $87.00 | $24.15 |
|
72040
X-ray of upper spine, 2-3 views
|
59 | 59 | $63.00 | $37.17 |
|
78306
Nuclear medicine study of bone and/or joint whole body
|
58 | 51 | $489.00 | $264.92 |
|
73564
X-ray of knee, 4 or more views
|
49 | 45 | $90.45 | $51.41 |
|
74183
Mri scan of abdomen before and after contrast
|
46 | 45 | $950.00 | $341.13 |
|
76377
3D radiographic procedure with computerized image postprocessing
|
46 | 46 | $137.00 | $69.46 |
|
72072
X-ray of middle spine, 3 views
|
45 | 44 | $62.13 | $35.51 |
|
77077
X-ray of joints, multiple
|
44 | 44 | $71.00 | $43.63 |
|
73130
X-ray of hand, minimum of 3 views
|
43 | 43 | $69.58 | $42.08 |
|
71271
Low dose ct scan of chest for lung cancer screening
|
42 | 42 | $292.00 | $136.37 |
|
74178
Ct scan of abdomen and pelvis before and after contrast
|
39 | 39 | $665.00 | $343.13 |
|
72120
X-ray lower and sacral spine including bending views 2 or 3 views
|
38 | 38 | $76.00 | $39.05 |
|
72197
Mri scan of pelvis before and after contrast
|
36 | 36 | $949.00 | $334.34 |
|
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
|
35 | 35 | $107.00 | $50.83 |
|
70551
Mri scan of brain without contrast
|
29 | 29 | $585.00 | $196.78 |
|
72141
MRI scan of upper spinal canal
|
29 | 29 | $525.00 | $183.85 |
|
73610
X-ray of ankle, minimum of 3 views
|
28 | 26 | $56.54 | $34.47 |
|
74019
X-ray of abdomen, 2 views
|
25 | 25 | $63.00 | $34.17 |
|
70491
CT scan of neck with contrast
|
24 | 22 | $444.00 | $150.23 |
|
77065
Diagnostic mammography of 1 breast
|
24 | 24 | $227.00 | $116.56 |
|
72202
X-ray of joint between lower spine and hip bone, 3 or more views
|
23 | 23 | $60.13 | $35.95 |
|
73560
X-ray of knee, 1-2 views
|
22 | 22 | $96.59 | $51.08 |
|
73620
X-ray of foot, 2 views
|
21 | 21 | $91.00 | $48.95 |
|
72170
X-ray of pelvis, 1-2 views
|
21 | 21 | $60.00 | $26.70 |
|
71045
X-ray of chest, 1 view
|
20 | 20 | $48.05 | $23.92 |
|
72158
Mri scan of lower spinal canal before and after contrast
|
19 | 19 | $782.00 | $311.28 |
|
73721
Mri scan of leg joint without contrast
|
19 | 18 | $561.00 | $194.76 |
|
73110
X-ray of wrist, minimum of 3 views
|
18 | 18 | $67.33 | $39.69 |
|
77074
X-ray of bones
|
18 | 18 | $122.00 | $62.48 |
|
76642
Limited ultrasound scan of 1 breast
|
18 | 18 | $187.78 | $83.58 |
|
76882
Limited ultrasound scan of joint or other extremity structure except blood vessels
|
16 | 15 | $101.00 | $52.06 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
16 | 15 | $92.00 | $46.49 |
|
77066
Diagnostic mammography of both breasts
|
16 | 16 | $440.00 | $151.86 |
|
78816
Nuclear medicine study whole body with ct scan
|
16 | 14 | $2151.00 | $1084.96 |
|
72070
X-ray of middle spine, 2 views
|
16 | 16 | $64.00 | $31.32 |
|
73522
X-ray of both hips, 3-4 views
|
16 | 15 | $92.00 | $51.09 |
|
73080
X-ray of elbow, minimum of 3 views
|
15 | 15 | $63.00 | $33.71 |
|
71275
Ct scan of blood vessels of chest with contrast
|
14 | 14 | $566.00 | $241.32 |
|
78264
Stomach emptying study
|
14 | 13 | $646.00 | $279.55 |
|
A9541
Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries
|
13 | 12 | $335.00 | $56.88 |
|
76981
Elastography ultrasound of organ tissue
|
13 | 13 | $205.00 | $99.92 |
|
77049
Mri of both breasts with and without contrast
|
13 | 13 | $768.00 | $345.41 |
|
73221
Mri scan of arm joint without contrast
|
13 | 13 | $591.23 | $219.15 |
|
72156
Mri scan of upper spinal canal before and after contrast
|
13 | 13 | $795.00 | $297.35 |
|
72146
Mri scan of middle spinal canal
|
13 | 12 | $529.00 | $167.06 |
|
76870
Ultrasound scan of scrotum
|
12 | 12 | $154.00 | $97.18 |
|
73700
Ct scan of leg without contrast
|
12 | 12 | $332.58 | $134.37 |
|
78226
Imaging of liver and bile duct system
|
11 | 11 | $640.00 | $290.16 |
|
72131
CT scan of lower spine
|
11 | 11 | $307.00 | $110.59 |
|
A9537
Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries
|
11 | 11 | $150.00 | $62.28 |
|
70490
Ct scan of soft tissue of neck without contrast
|
11 | 11 | $335.00 | $137.06 |
|
73523
X-ray of both hips, minimum of 5 views
|
11 | 11 | $107.00 | $57.98 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
A9575
Injection, gadoterate meglumine, 0.1 ml
|
25,482 | 160 | $1.00 | $0.16 |
|
Q9967
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
|
19,979 | 203 | $1.00 | $0.12 |
|
77067
Screening mammography
|
355 | 355 | $203.00 | $123.86 |
|
77063
Screening digital tomography of both breasts
|
353 | 353 | $107.00 | $52.13 |
|
71045
X-ray of chest, 1 view
|
299 | 249 | $36.00 | $8.87 |
|
71046
X-ray of chest, 2 views
|
245 | 234 | $57.71 | $31.43 |
|
77067
Screening mammography
|
226 | 226 | $153.00 | $36.40 |
|
77063
Screening digital tomography of both breasts
|
220 | 220 | $60.00 | $29.00 |
|
71250
Ct scan of chest without contrast
|
133 | 127 | $309.00 | $131.49 |
|
71046
X-ray of chest, 2 views
|
115 | 113 | $43.00 | $10.53 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
114 | 114 | $41.00 | $9.59 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
113 | 108 | $586.00 | $314.36 |
|
74018
X-ray of abdomen, 1 view
|
111 | 100 | $51.84 | $27.32 |
|
70450
Ct scan head or brain without contrast
|
110 | 103 | $169.00 | $39.82 |
|
71260
Ct scan of chest with contrast
|
106 | 99 | $432.00 | $126.16 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
103 | 102 | $136.00 | $56.41 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
100 | 92 | $365.00 | $87.88 |
|
70553
Mri scan of brain before and after contrast
|
87 | 86 | $795.00 | $326.82 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
84 | 84 | $64.43 | $36.66 |
|
73630
X-ray of foot, minimum of 3 views
|
83 | 74 | $62.42 | $36.00 |
|
76705
Limited ultrasound scan of abdomen
|
82 | 81 | $208.00 | $85.97 |
|
73030
X-ray of shoulder, minimum of 2 views
|
76 | 76 | $62.07 | $35.82 |
|
72148
MRI scan of lower spinal canal
|
72 | 72 | $522.00 | $192.59 |
|
A9552
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
|
64 | 60 | $871.00 | $172.81 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
64 | 61 | $348.00 | $84.15 |
|
71275
Ct scan of blood vessels of chest with contrast
|
61 | 58 | $364.00 | $85.72 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
60 | 57 | $2120.00 | $1099.48 |
|
72040
X-ray of upper spine, 2-3 views
|
57 | 57 | $62.28 | $35.87 |
|
73562
X-ray of knee, 3 views
|
56 | 55 | $86.14 | $48.33 |
|
74018
X-ray of abdomen, 1 view
|
53 | 47 | $36.00 | $8.89 |
|
73502
X-ray of hip, 2-3 views
|
53 | 52 | $76.94 | $43.45 |
|
77077
X-ray of joints, multiple
|
50 | 48 | $71.00 | $43.58 |
|
A9503
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
|
49 | 47 | $87.00 | $25.53 |
|
71250
Ct scan of chest without contrast
|
48 | 46 | $203.00 | $51.11 |
|
78306
Nuclear medicine study of bone and/or joint whole body
|
47 | 45 | $489.00 | $283.46 |
|
72125
Ct scan of upper spine without contrast
|
46 | 44 | $213.00 | $47.48 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
44 | 41 | $46.00 | $10.74 |
|
76536
Ultrasound of head and neck
|
42 | 42 | $220.00 | $108.65 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
42 | 42 | $119.00 | $35.39 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
39 | 38 | $382.00 | $188.28 |
|
73130
X-ray of hand, minimum of 3 views
|
39 | 39 | $66.92 | $39.70 |
|
73562
X-ray of knee, 3 views
|
36 | 33 | $39.00 | $9.21 |
|
73030
X-ray of shoulder, minimum of 2 views
|
36 | 35 | $39.00 | $9.21 |
|
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
|
34 | 34 | $108.91 | $52.73 |
|
73560
X-ray of knee, 1-2 views
|
32 | 24 | $38.00 | $8.06 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
32 | 30 | $90.13 | $46.80 |
|
72120
X-ray lower and sacral spine including bending views 2 or 3 views
|
31 | 31 | $76.00 | $36.62 |
|
76705
Limited ultrasound scan of abdomen
|
31 | 30 | $118.00 | $27.72 |
|
73502
X-ray of hip, 2-3 views
|
30 | 29 | $45.00 | $10.93 |
|
73564
X-ray of knee, 4 or more views
|
30 | 28 | $93.73 | $54.39 |
|
72072
X-ray of middle spine, 3 views
|
29 | 28 | $62.03 | $34.43 |
|
72148
MRI scan of lower spinal canal
|
29 | 28 | $295.00 | $68.55 |
|
70551
Mri scan of brain without contrast
|
29 | 29 | $585.00 | $200.55 |
|
74019
X-ray of abdomen, 2 views
|
28 | 28 | $63.00 | $34.19 |
|
72170
X-ray of pelvis, 1-2 views
|
28 | 28 | $60.00 | $25.57 |
|
77065
Diagnostic mammography of 1 breast
|
28 | 27 | $227.00 | $122.56 |
|
73130
X-ray of hand, minimum of 3 views
|
28 | 22 | $35.00 | $8.54 |
|
93971
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
|
27 | 26 | $90.00 | $21.69 |
|
72197
Mri scan of pelvis before and after contrast
|
26 | 25 | $949.00 | $357.30 |
|
70551
Mri scan of brain without contrast
|
25 | 25 | $294.00 | $70.54 |
|
76377
3D radiographic procedure with computerized image postprocessing
|
25 | 25 | $137.00 | $68.98 |
|
78452
Nuclear medicine studies of heart muscle at rest and with stress and spect
|
25 | 25 | $314.00 | $76.28 |
|
76770
Complete ultrasound scan behind abdominal cavity
|
24 | 24 | $146.00 | $35.63 |
|
73630
X-ray of foot, minimum of 3 views
|
23 | 22 | $34.00 | $8.23 |
|
73560
X-ray of knee, 1-2 views
|
23 | 22 | $96.39 | $48.85 |
|
71271
Low dose ct scan of chest for lung cancer screening
|
23 | 23 | $280.26 | $141.28 |
|
72141
MRI scan of upper spinal canal
|
22 | 22 | $525.00 | $177.08 |
|
74178
Ct scan of abdomen and pelvis before and after contrast
|
22 | 22 | $665.00 | $352.28 |
|
76642
Limited ultrasound scan of 1 breast
|
21 | 20 | $177.05 | $86.26 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
20 | 20 | $113.00 | $28.31 |
|
70553
Mri scan of brain before and after contrast
|
19 | 19 | $456.00 | $108.16 |
|
73110
X-ray of wrist, minimum of 3 views
|
19 | 19 | $73.42 | $41.38 |
|
73522
X-ray of both hips, 3-4 views
|
19 | 19 | $92.00 | $50.70 |
|
73523
X-ray of both hips, minimum of 5 views
|
19 | 19 | $103.05 | $55.19 |
|
72040
X-ray of upper spine, 2-3 views
|
19 | 19 | $46.00 | $10.93 |
|
74183
Mri scan of abdomen before and after contrast
|
17 | 17 | $950.00 | $348.00 |
|
73501
X-ray of hip with pelvis, 1 view
|
16 | 15 | $38.00 | $9.21 |
|
72050
X-ray of upper spine, 4 or 5 views
|
16 | 15 | $85.00 | $50.01 |
|
73610
X-ray of ankle, minimum of 3 views
|
16 | 16 | $65.25 | $38.50 |
|
71260
Ct scan of chest with contrast
|
16 | 16 | $248.00 | $54.51 |
|
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
|
16 | 16 | $60.00 | $29.47 |
|
72202
X-ray of joint between lower spine and hip bone, 3 or more views
|
16 | 16 | $59.31 | $34.82 |
|
73721
Mri scan of leg joint without contrast
|
15 | 15 | $673.20 | $242.68 |
|
73620
X-ray of foot, 2 views
|
15 | 15 | $91.47 | $51.78 |
|
72156
Mri scan of upper spinal canal before and after contrast
|
15 | 15 | $795.00 | $334.25 |
|
73610
X-ray of ankle, minimum of 3 views
|
15 | 14 | $36.00 | $8.54 |
|
70450
Ct scan head or brain without contrast
|
14 | 14 | $347.00 | $101.29 |
|
70491
CT scan of neck with contrast
|
14 | 13 | $444.00 | $157.18 |
|
93880
Ultrasound of both sides of head and neck blood flow
|
13 | 13 | $157.00 | $38.49 |
|
72131
CT scan of lower spine
|
13 | 13 | $199.00 | $47.53 |
|
72146
Mri scan of middle spinal canal
|
13 | 13 | $529.00 | $175.31 |
|
73221
Mri scan of arm joint without contrast
|
13 | 13 | $591.23 | $229.77 |
|
72158
Mri scan of lower spinal canal before and after contrast
|
13 | 13 | $782.00 | $314.27 |
|
71100
X-ray of ribs of one side of body, 2 views
|
13 | 13 | $62.00 | $34.75 |
|
73110
X-ray of wrist, minimum of 3 views
|
13 | 11 | $36.00 | $8.54 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
13 | 13 | $64.00 | $12.64 |
|
77066
Diagnostic mammography of both breasts
|
12 | 12 | $440.00 | $155.06 |
|
71045
X-ray of chest, 1 view
|
12 | 12 | $49.00 | $22.89 |
|
74246
X-ray of upper digestive tract with contrast
|
12 | 12 | $141.00 | $43.13 |
|
70498
Ct scan of blood vessels of neck with contrast
|
11 | 11 | $349.00 | $80.81 |
|
70496
Ct scan of blood vessels of head with contrast
|
11 | 11 | $350.00 | $83.87 |
|
76536
Ultrasound of head and neck
|
11 | 11 | $111.00 | $27.76 |
|
73080
X-ray of elbow, minimum of 3 views
|
11 | 11 | $58.00 | $28.76 |
|
78816
Nuclear medicine study whole body with ct scan
|
11 | 11 | $2151.00 | $1100.07 |
|
71275
Ct scan of blood vessels of chest with contrast
|
11 | 11 | $566.00 | $250.89 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
A9575
Injection, gadoterate meglumine, 0.1 ml
|
20,910 | 121 | $1.00 | $0.18 |
|
Q9967
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
|
16,295 | 166 | $1.00 | $0.11 |
|
71045
X-ray of chest, 1 view
|
310 | 255 | $36.00 | $9.22 |
|
77067
Screening mammography
|
239 | 239 | $153.00 | $38.48 |
|
77063
Screening digital tomography of both breasts
|
233 | 233 | $60.00 | $29.97 |
|
77067
Screening mammography
|
224 | 224 | $212.00 | $129.20 |
|
77063
Screening digital tomography of both breasts
|
223 | 223 | $107.00 | $52.80 |
|
71046
X-ray of chest, 2 views
|
210 | 205 | $58.00 | $30.85 |
|
71046
X-ray of chest, 2 views
|
173 | 153 | $43.00 | $10.98 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
128 | 127 | $66.00 | $36.02 |
|
70450
Ct scan head or brain without contrast
|
124 | 118 | $169.00 | $41.89 |
|
71250
Ct scan of chest without contrast
|
108 | 107 | $309.00 | $137.57 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
104 | 99 | $586.00 | $309.80 |
|
71260
Ct scan of chest with contrast
|
99 | 94 | $432.00 | $142.17 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
99 | 97 | $136.00 | $56.71 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
96 | 86 | $365.00 | $91.74 |
|
74018
X-ray of abdomen, 1 view
|
86 | 82 | $52.00 | $27.00 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
81 | 81 | $41.00 | $9.94 |
|
71250
Ct scan of chest without contrast
|
74 | 67 | $203.00 | $58.02 |
|
70553
Mri scan of brain before and after contrast
|
67 | 67 | $795.00 | $342.33 |
|
73030
X-ray of shoulder, minimum of 2 views
|
64 | 57 | $60.75 | $34.82 |
|
74018
X-ray of abdomen, 1 view
|
63 | 53 | $36.00 | $9.25 |
|
76705
Limited ultrasound scan of abdomen
|
60 | 60 | $208.00 | $86.51 |
|
72148
MRI scan of lower spinal canal
|
59 | 58 | $522.00 | $207.01 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
57 | 54 | $348.00 | $85.81 |
|
71275
Ct scan of blood vessels of chest with contrast
|
56 | 52 | $364.00 | $90.38 |
|
72125
Ct scan of upper spine without contrast
|
50 | 48 | $213.00 | $49.44 |
|
73562
X-ray of knee, 3 views
|
50 | 46 | $77.72 | $42.25 |
|
72040
X-ray of upper spine, 2-3 views
|
50 | 49 | $63.00 | $35.59 |
|
73502
X-ray of hip, 2-3 views
|
49 | 49 | $78.00 | $42.89 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
49 | 48 | $46.00 | $11.21 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
49 | 49 | $378.65 | $192.38 |
|
73030
X-ray of shoulder, minimum of 2 views
|
47 | 40 | $39.00 | $9.60 |
|
78452
Nuclear medicine studies of heart muscle at rest and with stress and spect
|
46 | 46 | $314.00 | $78.67 |
|
A9552
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
|
44 | 43 | $871.00 | $173.29 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
43 | 42 | $2120.00 | $1078.44 |
|
73562
X-ray of knee, 3 views
|
42 | 39 | $39.00 | $9.42 |
|
77077
X-ray of joints, multiple
|
36 | 35 | $71.00 | $40.81 |
|
A9503
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
|
36 | 33 | $87.00 | $24.34 |
|
72148
MRI scan of lower spinal canal
|
35 | 35 | $295.00 | $74.96 |
|
76705
Limited ultrasound scan of abdomen
|
35 | 34 | $118.00 | $29.39 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
34 | 32 | $92.00 | $46.18 |
|
78306
Nuclear medicine study of bone and/or joint whole body
|
34 | 31 | $489.00 | $290.55 |
|
76536
Ultrasound of head and neck
|
33 | 33 | $220.00 | $110.95 |
|
73502
X-ray of hip, 2-3 views
|
32 | 31 | $45.00 | $11.39 |
|
73630
X-ray of foot, minimum of 3 views
|
32 | 30 | $34.00 | $8.56 |
|
70551
Mri scan of brain without contrast
|
31 | 31 | $294.00 | $75.10 |
|
93971
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
|
31 | 31 | $90.00 | $22.55 |
|
73130
X-ray of hand, minimum of 3 views
|
29 | 25 | $35.00 | $8.91 |
|
76770
Complete ultrasound scan behind abdominal cavity
|
29 | 29 | $146.00 | $36.94 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
28 | 28 | $113.00 | $28.30 |
|
74183
Mri scan of abdomen before and after contrast
|
27 | 27 | $950.00 | $374.37 |
|
73560
X-ray of knee, 1-2 views
|
26 | 20 | $38.00 | $8.53 |
|
73620
X-ray of foot, 2 views
|
26 | 15 | $56.54 | $29.43 |
|
70553
Mri scan of brain before and after contrast
|
26 | 25 | $456.00 | $115.94 |
|
93880
Ultrasound of both sides of head and neck blood flow
|
24 | 24 | $157.00 | $40.37 |
|
73564
X-ray of knee, 4 or more views
|
23 | 22 | $86.87 | $48.68 |
|
72202
X-ray of joint between lower spine and hip bone, 3 or more views
|
23 | 22 | $62.00 | $35.30 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
22 | 22 | $64.00 | $13.18 |
|
74019
X-ray of abdomen, 2 views
|
21 | 21 | $63.00 | $34.28 |
|
70551
Mri scan of brain without contrast
|
21 | 21 | $585.00 | $213.97 |
|
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
|
20 | 20 | $107.00 | $53.71 |
|
73721
Mri scan of leg joint without contrast
|
20 | 20 | $561.00 | $210.78 |
|
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
|
19 | 19 | $60.00 | $30.32 |
|
72072
X-ray of middle spine, 3 views
|
19 | 19 | $65.00 | $36.74 |
|
73110
X-ray of wrist, minimum of 3 views
|
18 | 15 | $36.00 | $8.92 |
|
73221
Mri scan of arm joint without contrast
|
18 | 18 | $549.00 | $210.30 |
|
G0297
Low dose ct scan (ldct) for lung cancer screening
|
18 | 18 | $449.00 | $227.42 |
|
72170
X-ray of pelvis, 1-2 views
|
18 | 17 | $60.00 | $27.33 |
|
73560
X-ray of knee, 1-2 views
|
18 | 12 | $74.56 | $37.64 |
|
73130
X-ray of hand, minimum of 3 views
|
18 | 17 | $61.22 | $34.88 |
|
74246
X-ray of upper digestive tract with contrast
|
17 | 17 | $141.00 | $45.43 |
|
70450
Ct scan head or brain without contrast
|
17 | 17 | $347.00 | $104.72 |
|
73630
X-ray of foot, minimum of 3 views
|
17 | 16 | $57.59 | $33.41 |
|
72131
CT scan of lower spine
|
16 | 15 | $199.00 | $48.62 |
|
72158
Mri scan of lower spinal canal before and after contrast
|
16 | 16 | $782.00 | $294.87 |
|
73610
X-ray of ankle, minimum of 3 views
|
16 | 16 | $36.00 | $8.92 |
|
77065
Diagnostic mammography of 1 breast
|
16 | 12 | $153.00 | $41.35 |
|
76536
Ultrasound of head and neck
|
16 | 14 | $111.00 | $28.53 |
|
72141
MRI scan of upper spinal canal
|
16 | 16 | $525.00 | $191.19 |
|
72040
X-ray of upper spine, 2-3 views
|
15 | 15 | $46.00 | $11.40 |
|
72146
Mri scan of middle spinal canal
|
15 | 15 | $294.00 | $74.46 |
|
76642
Limited ultrasound scan of 1 breast
|
14 | 13 | $137.00 | $34.13 |
|
77065
Diagnostic mammography of 1 breast
|
14 | 14 | $185.43 | $128.74 |
|
71260
Ct scan of chest with contrast
|
14 | 13 | $248.00 | $61.96 |
|
74174
Ct scan of blood vessels of abdomen and pelvis with contrast
|
13 | 13 | $440.00 | $103.71 |
|
72072
X-ray of middle spine, 3 views
|
13 | 13 | $43.00 | $11.74 |
|
72141
MRI scan of upper spinal canal
|
13 | 13 | $294.00 | $74.65 |
|
73080
X-ray of elbow, minimum of 3 views
|
13 | 12 | $36.00 | $8.89 |
|
76377
3D radiographic procedure with computerized image postprocessing
|
12 | 12 | $137.00 | $70.69 |
|
70498
Ct scan of blood vessels of neck with contrast
|
12 | 12 | $349.00 | $84.83 |
|
73501
X-ray of hip with pelvis, 1 view
|
12 | 11 | $38.00 | $9.61 |
|
74178
Ct scan of abdomen and pelvis before and after contrast
|
12 | 12 | $665.00 | $329.04 |
|
93970
Ultrasound study of arm or leg veins with compression and maneuvers
|
11 | 11 | $139.00 | $35.01 |
|
71100
X-ray of ribs of one side of body, 2 views
|
11 | 11 | $62.00 | $34.16 |
|
70496
Ct scan of blood vessels of head with contrast
|
11 | 11 | $350.00 | $87.81 |
|
70470
Ct scan of head or brain before and after contrast
|
11 | 11 | $363.00 | $171.33 |
|
73522
X-ray of both hips, 3-4 views
|
11 | 11 | $92.00 | $45.11 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
11 | 11 | $490.00 | $119.61 |
|
76642
Limited ultrasound scan of 1 breast
|
11 | 11 | $184.36 | $88.13 |
|
72131
CT scan of lower spine
|
11 | 11 | $288.18 | $116.33 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
A9575
Injection, gadoterate meglumine, 0.1 ml
|
20,370 | 121 | $1.00 | $0.20 |
|
Q9967
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
|
18,399 | 188 | $1.00 | $0.11 |
|
71045
X-ray of chest, 1 view
|
359 | 240 | $36.00 | $9.15 |
|
77067
Screening mammography
|
342 | 342 | $250.62 | $127.13 |
|
77063
Screening digital tomography of both breasts
|
338 | 338 | $106.82 | $52.29 |
|
71046
X-ray of chest, 2 views
|
328 | 316 | $57.71 | $29.07 |
|
71046
X-ray of chest, 2 views
|
250 | 224 | $43.00 | $10.84 |
|
77067
Screening mammography
|
236 | 236 | $153.00 | $37.31 |
|
77063
Screening digital tomography of both breasts
|
229 | 229 | $60.00 | $29.41 |
|
70450
Ct scan head or brain without contrast
|
185 | 172 | $169.00 | $41.68 |
|
71250
Ct scan of chest without contrast
|
169 | 159 | $307.26 | $145.22 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
130 | 128 | $65.48 | $33.93 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
109 | 106 | $365.00 | $90.94 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
98 | 95 | $348.00 | $86.88 |
|
74018
X-ray of abdomen, 1 view
|
95 | 91 | $52.00 | $25.60 |
|
71260
Ct scan of chest with contrast
|
94 | 87 | $432.00 | $145.90 |
|
72148
MRI scan of lower spinal canal
|
94 | 94 | $522.00 | $196.73 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
92 | 84 | $586.00 | $300.74 |
|
71250
Ct scan of chest without contrast
|
85 | 79 | $203.00 | $57.83 |
|
A9552
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
|
77 | 73 | $871.00 | $172.20 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
71 | 67 | $2093.49 | $1052.08 |
|
72125
Ct scan of upper spine without contrast
|
71 | 68 | $213.00 | $52.69 |
|
73562
X-ray of knee, 3 views
|
69 | 59 | $75.74 | $39.45 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
68 | 68 | $41.00 | $9.87 |
|
72040
X-ray of upper spine, 2-3 views
|
67 | 67 | $61.78 | $33.48 |
|
76770
Complete ultrasound scan behind abdominal cavity
|
66 | 65 | $216.00 | $106.39 |
|
73502
X-ray of hip, 2-3 views
|
66 | 64 | $77.15 | $39.35 |
|
70553
Mri scan of brain before and after contrast
|
64 | 64 | $795.00 | $345.90 |
|
73562
X-ray of knee, 3 views
|
63 | 51 | $39.00 | $9.48 |
|
73030
X-ray of shoulder, minimum of 2 views
|
59 | 53 | $55.83 | $29.16 |
|
71275
Ct scan of blood vessels of chest with contrast
|
57 | 57 | $364.00 | $90.13 |
|
74018
X-ray of abdomen, 1 view
|
55 | 46 | $36.00 | $9.15 |
|
76705
Limited ultrasound scan of abdomen
|
53 | 52 | $208.00 | $85.05 |
|
73620
X-ray of foot, 2 views
|
52 | 30 | $54.00 | $27.53 |
|
78452
Nuclear medicine studies of heart muscle at rest and with stress and spect
|
51 | 51 | $314.00 | $78.97 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
51 | 50 | $382.00 | $189.74 |
|
77077
X-ray of joints, multiple
|
50 | 50 | $70.50 | $35.92 |
|
73030
X-ray of shoulder, minimum of 2 views
|
49 | 42 | $39.00 | $9.48 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
48 | 47 | $46.00 | $11.26 |
|
73502
X-ray of hip, 2-3 views
|
46 | 44 | $45.00 | $11.09 |
|
70551
Mri scan of brain without contrast
|
43 | 43 | $585.00 | $209.22 |
|
73130
X-ray of hand, minimum of 3 views
|
42 | 35 | $35.00 | $8.65 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
40 | 38 | $90.50 | $47.04 |
|
73630
X-ray of foot, minimum of 3 views
|
39 | 37 | $34.00 | $7.98 |
|
73560
X-ray of knee, 1-2 views
|
37 | 32 | $38.00 | $8.29 |
|
93971
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
|
37 | 35 | $90.00 | $22.59 |
|
76705
Limited ultrasound scan of abdomen
|
35 | 33 | $118.00 | $29.13 |
|
76536
Ultrasound of head and neck
|
34 | 33 | $220.00 | $108.95 |
|
A9503
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
|
33 | 32 | $87.00 | $23.40 |
|
72141
MRI scan of upper spinal canal
|
33 | 33 | $525.00 | $186.65 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
32 | 32 | $133.53 | $53.01 |
|
78306
Nuclear medicine study of bone and/or joint whole body
|
32 | 31 | $489.00 | $289.85 |
|
73560
X-ray of knee, 1-2 views
|
32 | 20 | $64.81 | $31.24 |
|
76770
Complete ultrasound scan behind abdominal cavity
|
30 | 28 | $146.00 | $36.94 |
|
72148
MRI scan of lower spinal canal
|
30 | 30 | $295.00 | $74.30 |
|
70551
Mri scan of brain without contrast
|
29 | 28 | $294.00 | $73.94 |
|
72146
Mri scan of middle spinal canal
|
29 | 29 | $529.00 | $210.05 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
29 | 29 | $115.59 | $36.91 |
|
73221
Mri scan of arm joint without contrast
|
29 | 28 | $549.00 | $218.02 |
|
73630
X-ray of foot, minimum of 3 views
|
26 | 24 | $56.08 | $30.09 |
|
73610
X-ray of ankle, minimum of 3 views
|
25 | 23 | $36.00 | $8.56 |
|
73110
X-ray of wrist, minimum of 3 views
|
25 | 22 | $36.00 | $8.62 |
|
72158
Mri scan of lower spinal canal before and after contrast
|
24 | 24 | $782.00 | $348.18 |
|
72040
X-ray of upper spine, 2-3 views
|
24 | 21 | $46.00 | $11.26 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
24 | 24 | $113.00 | $28.72 |
|
70450
Ct scan head or brain without contrast
|
23 | 21 | $335.61 | $102.56 |
|
72131
CT scan of lower spine
|
23 | 23 | $199.00 | $49.07 |
|
73130
X-ray of hand, minimum of 3 views
|
22 | 19 | $58.00 | $31.21 |
|
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
|
22 | 22 | $60.00 | $29.95 |
|
77065
Diagnostic mammography of 1 breast
|
21 | 20 | $170.00 | $126.95 |
|
73080
X-ray of elbow, minimum of 3 views
|
21 | 20 | $36.00 | $8.79 |
|
93880
Ultrasound of both sides of head and neck blood flow
|
20 | 20 | $157.00 | $40.24 |
|
71260
Ct scan of chest with contrast
|
20 | 20 | $248.00 | $60.63 |
|
72202
X-ray of joint between lower spine and hip bone, 3 or more views
|
20 | 20 | $62.00 | $32.03 |
|
73721
Mri scan of leg joint without contrast
|
19 | 19 | $561.00 | $216.33 |
|
70553
Mri scan of brain before and after contrast
|
19 | 18 | $456.00 | $109.90 |
|
93970
Ultrasound study of arm or leg veins with compression and maneuvers
|
19 | 19 | $139.00 | $34.63 |
|
74178
Ct scan of abdomen and pelvis before and after contrast
|
19 | 19 | $665.00 | $340.97 |
|
72072
X-ray of middle spine, 3 views
|
19 | 19 | $63.79 | $34.09 |
|
72050
X-ray of upper spine, 4 or 5 views
|
19 | 19 | $85.00 | $45.41 |
|
70486
CT scan of face
|
18 | 18 | $169.00 | $42.02 |
|
71100
X-ray of ribs of one side of body, 2 views
|
18 | 18 | $62.00 | $32.35 |
|
74183
Mri scan of abdomen before and after contrast
|
18 | 18 | $950.00 | $377.82 |
|
77065
Diagnostic mammography of 1 breast
|
18 | 18 | $153.00 | $40.89 |
|
76536
Ultrasound of head and neck
|
17 | 17 | $111.00 | $28.18 |
|
73522
X-ray of both hips, 3-4 views
|
15 | 15 | $92.00 | $46.54 |
|
74019
X-ray of abdomen, 2 views
|
15 | 15 | $63.00 | $31.31 |
|
72170
X-ray of pelvis, 1-2 views
|
15 | 15 | $60.00 | $29.02 |
|
73551
X-ray of thigh bone, 1 view
|
14 | 12 | $34.00 | $8.43 |
|
70491
CT scan of neck with contrast
|
14 | 11 | $444.00 | $160.82 |
|
73610
X-ray of ankle, minimum of 3 views
|
14 | 14 | $58.00 | $31.35 |
|
73110
X-ray of wrist, minimum of 3 views
|
14 | 14 | $66.00 | $34.27 |
|
73721
Mri scan of leg joint without contrast
|
14 | 14 | $270.00 | $68.32 |
|
76642
Limited ultrasound scan of 1 breast
|
14 | 14 | $169.00 | $83.64 |
|
77002
Fluoroscopic guidance for needle placement
|
14 | 13 | $110.00 | $27.79 |
|
72146
Mri scan of middle spinal canal
|
14 | 14 | $294.00 | $73.87 |
|
72072
X-ray of middle spine, 3 views
|
13 | 13 | $43.00 | $10.91 |
|
76856
Complete ultrasound scan of pelvis
|
13 | 13 | $209.00 | $104.09 |
|
74230
Imaging for evaluation of swallowing function
|
13 | 12 | $106.00 | $26.76 |
|
73221
Mri scan of arm joint without contrast
|
13 | 13 | $271.00 | $68.31 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
13 | 13 | $64.00 | $15.84 |
|
20610
Aspiration and/or injection of fluid from large joint
|
12 | 11 | $184.00 | $46.31 |
|
72141
MRI scan of upper spinal canal
|
12 | 12 | $294.00 | $74.36 |
|
76830
Ultrasound pelvis through vagina
|
12 | 12 | $232.00 | $115.61 |
|
72131
CT scan of lower spine
|
12 | 12 | $307.00 | $137.56 |
|
73080
X-ray of elbow, minimum of 3 views
|
12 | 11 | $58.00 | $27.68 |
|
73501
X-ray of hip with pelvis, 1 view
|
12 | 11 | $38.00 | $9.48 |
|
73564
X-ray of knee, 4 or more views
|
11 | 11 | $87.45 | $46.10 |
|
72192
Ct scan pelvis
|
11 | 11 | $217.00 | $54.61 |
|
74246
X-ray of upper digestive tract with contrast
|
11 | 11 | $141.00 | $34.54 |
|
76857
Limited ultrasound scan of pelvis
|
11 | 11 | $97.00 | $25.03 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
11 | 11 | $490.00 | $119.23 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
Q9967
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
|
18,287 | 195 | $1.00 | $0.12 |
|
A9575
Injection, gadoterate meglumine, 0.1 ml
|
3,820 | 28 | $1.05 | $0.20 |
|
A9579
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml
|
1,377 | 80 | $5.00 | $1.82 |
|
71045
X-ray of chest, 1 view
|
367 | 271 | $36.00 | $8.99 |
|
71046
X-ray of chest, 2 views
|
330 | 321 | $57.78 | $27.54 |
|
77067
Screening mammography
|
321 | 321 | $156.00 | $126.95 |
|
77063
Screening digital tomography of both breasts
|
294 | 294 | $106.80 | $51.60 |
|
71046
X-ray of chest, 2 views
|
270 | 245 | $43.00 | $10.65 |
|
77067
Screening mammography
|
227 | 227 | $153.00 | $36.55 |
|
77063
Screening digital tomography of both breasts
|
219 | 219 | $60.00 | $28.88 |
|
70450
Ct scan head or brain without contrast
|
204 | 192 | $169.00 | $41.09 |
|
71250
Ct scan of chest without contrast
|
168 | 161 | $307.77 | $149.14 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
139 | 138 | $66.00 | $31.95 |
|
71260
Ct scan of chest with contrast
|
103 | 98 | $432.00 | $146.98 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
95 | 90 | $348.00 | $85.58 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
94 | 92 | $586.00 | $287.15 |
|
76770
Complete ultrasound scan behind abdominal cavity
|
91 | 90 | $216.00 | $105.12 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
85 | 84 | $365.00 | $90.20 |
|
72148
MRI scan of lower spinal canal
|
78 | 78 | $522.00 | $196.59 |
|
74018
X-ray of abdomen, 1 view
|
76 | 74 | $52.00 | $24.79 |
|
A9552
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
|
75 | 75 | $871.00 | $165.90 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
73 | 73 | $41.00 | $10.00 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
72 | 72 | $2093.86 | $1028.55 |
|
71250
Ct scan of chest without contrast
|
64 | 64 | $203.00 | $57.19 |
|
72125
Ct scan of upper spine without contrast
|
62 | 60 | $213.00 | $52.22 |
|
73562
X-ray of knee, 3 views
|
61 | 59 | $85.67 | $40.04 |
|
71275
Ct scan of blood vessels of chest with contrast
|
60 | 58 | $364.00 | $89.27 |
|
73630
X-ray of foot, minimum of 3 views
|
57 | 45 | $34.00 | $8.33 |
|
72040
X-ray of upper spine, 2-3 views
|
57 | 57 | $62.28 | $29.77 |
|
70553
Mri scan of brain before and after contrast
|
56 | 56 | $795.00 | $344.08 |
|
76705
Limited ultrasound scan of abdomen
|
56 | 55 | $208.00 | $82.74 |
|
74018
X-ray of abdomen, 1 view
|
53 | 50 | $36.00 | $9.02 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
52 | 52 | $46.00 | $10.95 |
|
73502
X-ray of hip, 2-3 views
|
50 | 47 | $74.84 | $36.55 |
|
78452
Nuclear medicine studies of heart muscle at rest and with stress and spect
|
48 | 48 | $314.00 | $78.12 |
|
73030
X-ray of shoulder, minimum of 2 views
|
43 | 42 | $59.02 | $29.91 |
|
93971
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
|
43 | 42 | $90.00 | $22.26 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
43 | 43 | $382.00 | $188.70 |
|
72141
MRI scan of upper spinal canal
|
42 | 42 | $525.00 | $186.88 |
|
A9503
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
|
42 | 41 | $87.00 | $23.94 |
|
76705
Limited ultrasound scan of abdomen
|
41 | 41 | $118.00 | $28.96 |
|
73562
X-ray of knee, 3 views
|
40 | 35 | $39.00 | $9.35 |
|
70551
Mri scan of brain without contrast
|
38 | 38 | $585.00 | $217.63 |
|
70450
Ct scan head or brain without contrast
|
34 | 33 | $347.00 | $106.32 |
|
78306
Nuclear medicine study of bone and/or joint whole body
|
33 | 32 | $489.00 | $291.97 |
|
73110
X-ray of wrist, minimum of 3 views
|
32 | 29 | $36.00 | $8.21 |
|
73130
X-ray of hand, minimum of 3 views
|
31 | 27 | $35.00 | $8.45 |
|
76770
Complete ultrasound scan behind abdominal cavity
|
31 | 31 | $146.00 | $36.43 |
|
73020
X-ray of shoulder, 1 view
|
30 | 29 | $32.00 | $7.97 |
|
73721
Mri scan of leg joint without contrast
|
29 | 28 | $561.00 | $209.24 |
|
72148
MRI scan of lower spinal canal
|
28 | 27 | $295.00 | $71.29 |
|
93970
Ultrasound study of arm or leg veins with compression and maneuvers
|
27 | 26 | $139.00 | $34.14 |
|
93880
Ultrasound of both sides of head and neck blood flow
|
27 | 27 | $157.00 | $39.63 |
|
73221
Mri scan of arm joint without contrast
|
27 | 27 | $549.00 | $218.16 |
|
76536
Ultrasound of head and neck
|
26 | 26 | $220.00 | $106.07 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
26 | 26 | $113.00 | $27.57 |
|
70551
Mri scan of brain without contrast
|
26 | 26 | $294.00 | $70.83 |
|
71260
Ct scan of chest with contrast
|
25 | 22 | $248.00 | $60.67 |
|
73560
X-ray of knee, 1-2 views
|
24 | 22 | $38.00 | $8.31 |
|
73501
X-ray of hip with pelvis, 1 view
|
24 | 22 | $38.00 | $9.34 |
|
74178
Ct scan of abdomen and pelvis before and after contrast
|
24 | 24 | $665.00 | $313.45 |
|
73630
X-ray of foot, minimum of 3 views
|
23 | 23 | $56.35 | $28.07 |
|
73502
X-ray of hip, 2-3 views
|
23 | 23 | $45.00 | $11.08 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
22 | 21 | $490.00 | $117.44 |
|
72072
X-ray of middle spine, 3 views
|
21 | 21 | $65.00 | $32.23 |
|
77077
X-ray of joints, multiple
|
21 | 21 | $71.00 | $32.85 |
|
72146
Mri scan of middle spinal canal
|
21 | 21 | $529.00 | $204.97 |
|
73721
Mri scan of leg joint without contrast
|
21 | 21 | $270.00 | $67.34 |
|
77065
Diagnostic mammography of 1 breast
|
20 | 20 | $170.00 | $126.98 |
|
72158
Mri scan of lower spinal canal before and after contrast
|
19 | 19 | $782.00 | $338.74 |
|
70553
Mri scan of brain before and after contrast
|
19 | 18 | $456.00 | $112.96 |
|
74019
X-ray of abdomen, 2 views
|
18 | 18 | $63.00 | $30.99 |
|
72131
CT scan of lower spine
|
18 | 18 | $295.50 | $125.13 |
|
73221
Mri scan of arm joint without contrast
|
17 | 16 | $271.00 | $67.08 |
|
74022
Complete x-ray study of abdomen with single x-ray of chest
|
17 | 17 | $63.00 | $15.96 |
|
73620
X-ray of foot, 2 views
|
17 | 16 | $60.53 | $28.46 |
|
73610
X-ray of ankle, minimum of 3 views
|
17 | 16 | $36.00 | $8.65 |
|
73700
Ct scan of leg without contrast
|
16 | 12 | $326.19 | $151.32 |
|
72131
CT scan of lower spine
|
16 | 16 | $199.00 | $47.61 |
|
73590
X-ray of lower leg, 2 views
|
16 | 14 | $35.00 | $8.32 |
|
71100
X-ray of ribs of one side of body, 2 views
|
16 | 16 | $62.00 | $31.16 |
|
73080
X-ray of elbow, minimum of 3 views
|
16 | 15 | $36.00 | $7.75 |
|
72040
X-ray of upper spine, 2-3 views
|
16 | 16 | $46.00 | $11.09 |
|
72141
MRI scan of upper spinal canal
|
15 | 15 | $294.00 | $72.76 |
|
76856
Complete ultrasound scan of pelvis
|
15 | 15 | $209.00 | $104.65 |
|
74183
Mri scan of abdomen before and after contrast
|
15 | 15 | $950.00 | $379.38 |
|
74246
X-ray of upper digestive tract with contrast
|
15 | 15 | $141.00 | $32.46 |
|
73521
X-ray of both hips, 2 views
|
15 | 15 | $74.00 | $34.58 |
|
73030
X-ray of shoulder, minimum of 2 views
|
14 | 14 | $39.00 | $8.76 |
|
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
|
14 | 14 | $60.00 | $29.54 |
|
72192
Ct scan pelvis
|
14 | 14 | $217.00 | $53.42 |
|
76830
Ultrasound pelvis through vagina
|
13 | 13 | $232.00 | $115.42 |
|
74178
Ct scan of abdomen and pelvis before and after contrast
|
13 | 13 | $402.00 | $98.83 |
|
78306
Nuclear medicine study of bone and/or joint whole body
|
12 | 11 | $168.00 | $41.99 |
|
73610
X-ray of ankle, minimum of 3 views
|
12 | 12 | $62.83 | $31.08 |
|
70486
CT scan of face
|
12 | 12 | $304.00 | $130.92 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
12 | 12 | $92.00 | $41.60 |
|
72072
X-ray of middle spine, 3 views
|
11 | 11 | $43.00 | $10.77 |
|
71275
Ct scan of blood vessels of chest with contrast
|
11 | 11 | $566.00 | $272.62 |
|
77002
Fluoroscopic guidance for needle placement
|
11 | 11 | $110.00 | $27.70 |
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
Q9967
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
|
21,346 | 226 | $1.00 | $0.12 |
|
A9579
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml
|
2,174 | 133 | $5.00 | $1.83 |
|
71020
X-ray of chest, 2 views, front and side
|
406 | 385 | $52.79 | $26.02 |
|
71010
X-ray of chest, 1 view, front
|
405 | 296 | $36.00 | $8.96 |
|
G0202
Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed
|
350 | 350 | $262.00 | $123.93 |
|
71020
X-ray of chest, 2 views, front and side
|
301 | 267 | $43.00 | $10.71 |
|
71250
Ct scan of chest without contrast
|
209 | 199 | $309.00 | $149.88 |
|
G0202
Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed
|
207 | 207 | $144.00 | $36.12 |
|
77063
Screening digital tomography of both breasts
|
193 | 193 | $60.00 | $29.51 |
|
70450
Ct scan head or brain without contrast
|
171 | 161 | $169.00 | $40.99 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
156 | 151 | $65.72 | $32.53 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
118 | 110 | $586.00 | $281.59 |
|
76770
Complete ultrasound scan behind abdominal cavity
|
109 | 108 | $216.00 | $106.80 |
|
74000
X-ray of abdomen, single view
|
103 | 96 | $44.74 | $22.11 |
|
71260
Ct scan of chest with contrast
|
93 | 84 | $432.00 | $164.92 |
|
74177
Ct scan of abdomen and pelvis with contrast
|
87 | 84 | $365.00 | $89.46 |
|
72148
MRI scan of lower spinal canal
|
87 | 86 | $517.71 | $197.22 |
|
A9552
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
|
86 | 78 | $871.00 | $170.83 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
79 | 75 | $348.00 | $86.14 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
77 | 72 | $2095.56 | $1032.47 |
|
73502
X-ray of hip, 2-3 views
|
75 | 73 | $78.00 | $38.71 |
|
72125
Ct scan of upper spine without contrast
|
73 | 72 | $213.00 | $52.26 |
|
72100
X-ray of lower and sacral spine, 2-3 views
|
66 | 60 | $46.00 | $11.05 |
|
72040
X-ray of upper spine, 2-3 views
|
64 | 64 | $62.36 | $30.24 |
|
70553
Mri scan of brain before and after contrast
|
63 | 63 | $795.00 | $337.32 |
|
73562
X-ray of knee, 3 views
|
63 | 60 | $77.63 | $38.71 |
|
71250
Ct scan of chest without contrast
|
63 | 61 | $203.00 | $49.99 |
|
76705
Limited ultrasound scan of abdomen
|
60 | 59 | $208.00 | $83.78 |
|
73562
X-ray of knee, 3 views
|
60 | 52 | $39.00 | $9.32 |
|
71275
Ct scan of blood vessels of chest with contrast
|
59 | 56 | $364.00 | $88.38 |
|
74000
X-ray of abdomen, single view
|
52 | 43 | $36.00 | $8.98 |
|
74176
Ct scan of abdomen and pelvis without contrast
|
51 | 49 | $382.00 | $174.05 |
|
73721
Mri scan of leg joint without contrast
|
48 | 46 | $561.00 | $206.43 |
|
93971
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers
|
45 | 43 | $90.00 | $21.48 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
45 | 45 | $41.00 | $9.97 |
|
70551
Mri scan of brain without contrast
|
43 | 43 | $585.00 | $205.90 |
|
93880
Ultrasound of both sides of head and neck blood flow
|
43 | 43 | $157.00 | $37.95 |
|
78452
Nuclear medicine studies of heart muscle at rest and with stress and spect
|
41 | 41 | $314.00 | $74.80 |
|
73030
X-ray of shoulder, minimum of 2 views
|
39 | 39 | $59.54 | $29.52 |
|
73630
X-ray of foot, minimum of 3 views
|
39 | 29 | $34.00 | $8.17 |
|
72158
Mri scan of lower spinal canal before and after contrast
|
39 | 39 | $782.00 | $340.64 |
|
72141
MRI scan of upper spinal canal
|
38 | 38 | $525.00 | $193.14 |
|
72148
MRI scan of lower spinal canal
|
38 | 38 | $295.00 | $72.30 |
|
76536
Ultrasound of head and neck
|
35 | 34 | $220.00 | $106.98 |
|
73502
X-ray of hip, 2-3 views
|
33 | 31 | $45.00 | $11.05 |
|
A9503
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
|
33 | 33 | $87.00 | $25.02 |
|
76775
Limited ultrasound scan behind abdominal cavity
|
33 | 30 | $113.00 | $28.26 |
|
70450
Ct scan head or brain without contrast
|
33 | 33 | $347.00 | $106.88 |
|
73560
X-ray of knee, 1-2 views
|
31 | 27 | $38.00 | $8.31 |
|
74246
X-ray of upper digestive tract with contrast
|
30 | 30 | $141.00 | $33.35 |
|
76705
Limited ultrasound scan of abdomen
|
28 | 28 | $118.00 | $28.98 |
|
78306
Nuclear medicine study of bone and/or joint whole body
|
28 | 28 | $474.57 | $233.87 |
|
72131
CT scan of lower spine
|
28 | 28 | $199.00 | $48.04 |
|
73130
X-ray of hand, minimum of 3 views
|
27 | 24 | $35.00 | $8.66 |
|
73221
Mri scan of arm joint without contrast
|
27 | 26 | $566.15 | $224.37 |
|
73110
X-ray of wrist, minimum of 3 views
|
26 | 26 | $36.00 | $8.40 |
|
G0206
Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral
|
25 | 25 | $242.00 | $124.71 |
|
74020
Imaging of abdomen
|
24 | 23 | $71.00 | $33.07 |
|
70551
Mri scan of brain without contrast
|
24 | 24 | $294.00 | $72.71 |
|
78815
Nuclear medicine study from skull base to mid-thigh with ct scan
|
24 | 22 | $490.00 | $117.69 |
|
77080
Dxa bone density measurement of hip, pelvis, spine
|
24 | 24 | $119.00 | $38.08 |
|
72072
X-ray of middle spine, 3 views
|
22 | 20 | $65.00 | $32.19 |
|
73630
X-ray of foot, minimum of 3 views
|
22 | 21 | $56.45 | $28.42 |
|
73501
X-ray of hip with pelvis, 1 view
|
21 | 21 | $38.00 | $9.33 |
|
73610
X-ray of ankle, minimum of 3 views
|
19 | 19 | $36.00 | $8.64 |
|
70553
Mri scan of brain before and after contrast
|
19 | 19 | $456.00 | $105.63 |
|
73030
X-ray of shoulder, minimum of 2 views
|
19 | 17 | $39.00 | $9.33 |
|
70491
CT scan of neck with contrast
|
18 | 17 | $444.00 | $185.92 |
|
72110
X-ray of lower and sacral spine, minimum of 4 views
|
17 | 17 | $92.00 | $45.76 |
|
76770
Complete ultrasound scan behind abdominal cavity
|
17 | 17 | $146.00 | $36.36 |
|
70486
CT scan of face
|
17 | 17 | $169.00 | $40.54 |
|
74022
Complete x-ray study of abdomen with single x-ray of chest
|
17 | 17 | $63.00 | $15.94 |
|
76377
3D radiographic procedure with computerized image postprocessing
|
17 | 17 | $137.00 | $67.95 |
|
73080
X-ray of elbow, minimum of 3 views
|
17 | 16 | $36.00 | $8.65 |
|
73130
X-ray of hand, minimum of 3 views
|
17 | 17 | $75.06 | $37.40 |
|
73521
X-ray of both hips, 2 views
|
16 | 16 | $74.00 | $37.04 |
|
76642
Limited ultrasound scan of 1 breast
|
15 | 14 | $180.27 | $86.35 |
|
73721
Mri scan of leg joint without contrast
|
15 | 15 | $270.00 | $67.10 |
|
72072
X-ray of middle spine, 3 views
|
15 | 15 | $43.00 | $10.19 |
|
71260
Ct scan of chest with contrast
|
15 | 15 | $248.00 | $60.20 |
|
76536
Ultrasound of head and neck
|
14 | 14 | $111.00 | $27.64 |
|
73700
Ct scan of leg without contrast
|
14 | 13 | $301.57 | $147.72 |
|
72131
CT scan of lower spine
|
14 | 14 | $307.00 | $133.99 |
|
72192
Ct scan pelvis
|
13 | 13 | $217.00 | $54.00 |
|
73590
X-ray of lower leg, 2 views
|
13 | 12 | $35.00 | $7.80 |
|
72040
X-ray of upper spine, 2-3 views
|
13 | 12 | $46.00 | $10.31 |
|
71275
Ct scan of blood vessels of chest with contrast
|
13 | 13 | $566.00 | $258.06 |
|
70486
CT scan of face
|
13 | 13 | $304.00 | $126.51 |
|
72170
X-ray of pelvis, 1-2 views
|
13 | 13 | $36.00 | $8.64 |
|
72158
Mri scan of lower spinal canal before and after contrast
|
12 | 12 | $459.00 | $107.83 |
|
73020
X-ray of shoulder, 1 view
|
11 | 11 | $32.00 | $7.93 |
|
72141
MRI scan of upper spinal canal
|
11 | 11 | $294.00 | $72.27 |
|
93970
Ultrasound study of arm or leg veins with compression and maneuvers
|
11 | 11 | $139.00 | $34.29 |
|
72146
Mri scan of middle spinal canal
|
11 | 11 | $294.00 | $70.71 |
|
77002
Fluoroscopic guidance for needle placement
|
11 | 11 | $110.00 | $27.65 |
|
74183
Mri scan of abdomen before and after contrast
|
11 | 11 | $950.00 | $470.98 |
|
71100
X-ray of ribs of one side of body, 2 views
|
11 | 11 | $62.00 | $30.90 |
Medical Specialties & State Licenses
Radiology - Diagnostic Radiology
Primary Specialty
NUCC Taxonomy Code: 2085R0202X
State License
OH 35078027G
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Additional State Medicaid & Healthcare Payer Identifiers
Medicaid State Provider ID
2192916 (OH)
Hospital & Practice Group Affiliations
Toledo Clinic Incorporated
4235 Secor Rd, Toledo, OH 436234231
Phone: 4194795398
Practice Associates & Co-Workers
Healthcare professionals and specialists practicing at this location or sharing practice phone/fax
Dr. Gunvantray Mehta
, MD
NPI 1376565184
Radiology - Diagnostic Radiology
Doctor of Medicine (M.D.)
Dr. John D'souza
, MD
NPI 1770504318
Radiology - Diagnostic Radiology
Doctor of Medicine (M.D.)
Dr. Frederic Mattes
, MD
NPI 1982625356
Radiology - Diagnostic Radiology
Doctor of Medicine (M.D.)
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
✅
NPI Profile Active
July 08, 2007
NPI status registered as active in NPPES database
📍
Updated Practice Location
July 08, 2007
Registered at 3900 SUNFOREST CT STE 136, TOLEDO, OH 436234440 (Tel: 4194741104)
📍
Updated Business Mailing Address
July 08, 2007
Registered at 3036 W SYLVANIA AVE, TOLEDO, OH 436134128 (Tel: 4194730431)
👤
Provider Name / Credentials Updated
July 08, 2007
Recorded as PATRICK GUSTINE, M.D.
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty)
July 08, 2007
Radiology (License #35078027G in OH)
🟢
Initial NPI Registration & Enumeration
July 21, 2006
First registered as active Individual Practitioner in NPPES Database.
Patient & Community Reviews
Verified patient ratings, medical care experiences, and facility photos
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NPI Administrative Meta
NPI Number:
1548281116
Entity Type:
Individual Provider
Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date:
July 21, 2006
Last Update:
July 08, 2007
Sole Proprietor:
No
Mailing Address
3036 W Sylvania Ave
Toledo, OH 436134128
Phone: 4194730431
Public Domain Record
This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer
This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.