CPT
Code
70010
70015
70015
70015
70030
70030
70030
70100
70100
70100
70110
70110
70110
70120
70120
70120
70130
70130
70130
70134
70134
70134
70140
70140
70140
70150
70150
70150
70160
70160
70160
70170
70170
70170
70190
70190
70190
70200
70200
70200
70210
70210
70210
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Contrast x-ray of brain
Contrast x-ray of brain
Contrast x-ray of brain
Contrast x-ray of brain
X-ray eye for foreign body
X-ray eye for foreign body
X-ray eye for foreign body
X-ray exam of jaw <4views
X-ray exam of jaw <4views
X-ray exam of jaw <4views
X-ray exam of jaw 4/> views
X-ray exam of jaw 4/> views
X-ray exam of jaw 4/> views
X-ray exam of mastoids
X-ray exam of mastoids
X-ray exam of mastoids
X-ray exam of mastoids
X-ray exam of mastoids
X-ray exam of mastoids
X-ray exam of middle ear
X-ray exam of middle ear
X-ray exam of middle ear
X-ray exam of facial bones
X-ray exam of facial bones
X-ray exam of facial bones
X-ray exam of facial bones
X-ray exam of facial bones
X-ray exam of facial bones
X-ray exam of nasal bones
X-ray exam of nasal bones
X-ray exam of nasal bones
X-ray exam of tear duct
X-ray exam of tear duct
X-ray exam of tear duct
X-ray exam of eye sockets
X-ray exam of eye sockets
X-ray exam of eye sockets
X-ray exam of eye sockets
X-ray exam of eye sockets
X-ray exam of eye sockets
X-ray exam of sinuses
X-ray exam of sinuses
X-ray exam of sinuses
$73.66
$155.95
$61.45
$94.51
$27.67
$8.62
$19.04
$33.06
$9.34
$23.72
$38.09
$12.94
$25.15
$34.14
$9.34
$24.79
$54.98
$17.61
$37.37
$51.74
$17.97
$33.78
$29.82
$10.78
$19.04
$41.68
$13.65
$28.03
$32.70
$8.98
$23.72
$0.00
$15.81
$0.00
$35.21
$11.50
$23.72
$42.40
$14.37
$28.03
$29.82
$8.98
$20.84
Page 1 of 45
2016
Payment
Rate
$62.70
$154.42
$63.42
$91.00
$27.95
$8.60
$19.35
$32.96
$9.32
$23.65
$37.98
$12.90
$25.08
$34.04
$9.32
$24.72
$54.82
$17.56
$37.26
$51.59
$17.91
$33.68
$29.74
$10.75
$18.99
$41.56
$13.61
$27.95
$32.60
$8.96
$23.65
$0.00
$15.41
$0.00
$35.83
$11.46
$24.36
$42.28
$14.33
$27.95
$29.74
$8.96
$20.78
Percent
Change in
Payment Rate
-14.9%
-1.0%
3.2%
-3.7%
1.0%
-0.3%
1.6%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-2.6%
1.7%
-0.3%
2.7%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
CPT
Code
70220
70220
70220
70240
70240
70240
70250
70250
70250
70260
70260
70260
70300
70300
70300
70310
70310
70310
70320
70320
70320
70328
70328
70328
70330
70330
70330
70332
70332
70332
70336
70336
70336
70350
70350
70350
70355
70355
70355
70360
70360
70360
70370
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
X-ray exam of sinuses
X-ray exam of sinuses
X-ray exam of sinuses
X-ray exam pituitary saddle
X-ray exam pituitary saddle
X-ray exam pituitary saddle
X-ray exam of skull
X-ray exam of skull
X-ray exam of skull
X-ray exam of skull
X-ray exam of skull
X-ray exam of skull
X-ray exam of teeth
X-ray exam of teeth
X-ray exam of teeth
X-ray exam of teeth
X-ray exam of teeth
X-ray exam of teeth
Full mouth x-ray of teeth
Full mouth x-ray of teeth
Full mouth x-ray of teeth
X-ray exam of jaw joint
X-ray exam of jaw joint
X-ray exam of jaw joint
X-ray exam of jaw joints
X-ray exam of jaw joints
X-ray exam of jaw joints
X-ray exam of jaw joint
X-ray exam of jaw joint
X-ray exam of jaw joint
Magnetic image jaw joint
Magnetic image jaw joint
Magnetic image jaw joint
X-ray head for orthodontia
X-ray head for orthodontia
X-ray head for orthodontia
Panoramic x-ray of jaws
Panoramic x-ray of jaws
Panoramic x-ray of jaws
X-ray exam of neck
X-ray exam of neck
X-ray exam of neck
Throat x-ray & fluoroscopy
$37.37
$12.94
$24.43
$30.18
$10.42
$19.76
$35.93
$12.94
$23.00
$45.28
$17.61
$27.67
$15.09
$6.11
$8.98
$38.81
$8.62
$30.18
$53.90
$12.94
$40.96
$31.26
$9.70
$21.56
$47.43
$13.30
$34.14
$82.65
$32.70
$49.95
$322.32
$75.10
$247.22
$19.76
$10.42
$9.34
$20.48
$11.50
$8.98
$28.03
$8.62
$19.40
$81.21
Page 2 of 45
2016
Payment
Rate
$37.62
$12.90
$24.72
$30.10
$10.03
$20.06
$36.19
$12.90
$23.29
$45.86
$17.91
$27.95
$15.05
$6.09
$8.96
$36.90
$8.24
$28.66
$52.67
$12.18
$40.49
$30.81
$9.32
$21.50
$47.29
$12.90
$34.39
$82.05
$31.89
$50.16
$322.09
$74.88
$247.21
$20.06
$10.39
$9.67
$20.78
$11.46
$9.32
$28.30
$8.60
$19.71
$77.03
Percent
Change in
Payment Rate
0.7%
-0.3%
1.2%
-0.3%
-3.7%
1.5%
0.7%
-0.3%
1.3%
1.3%
1.7%
1.0%
-0.3%
-0.3%
-0.3%
-4.9%
-4.4%
-5.0%
-2.3%
-5.8%
-1.2%
-1.4%
-4.0%
-0.3%
-0.3%
-3.0%
0.8%
-0.7%
-2.5%
0.4%
-0.1%
-0.3%
-0.0%
1.5%
-0.3%
3.5%
1.5%
-0.3%
3.7%
1.0%
-0.3%
1.6%
-5.1%
CPT
Code
70370
70370
70371
70371
70371
70380
70380
70380
70390
70390
70390
70450
70450
70450
70460
70460
70460
70470
70470
70470
70480
70480
70480
70481
70481
70481
70482
70482
70482
70486
70486
70486
70487
70487
70487
70488
70488
70488
70490
70490
70490
70491
70491
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
Description
2015
Payment
Rate
Throat x-ray & fluoroscopy
Throat x-ray & fluoroscopy
Speech evaluation complex
Speech evaluation complex
Speech evaluation complex
X-ray exam of salivary gland
X-ray exam of salivary gland
X-ray exam of salivary gland
X-ray exam of salivary duct
X-ray exam of salivary duct
X-ray exam of salivary duct
Ct head/brain w/o dye
Ct head/brain w/o dye
Ct head/brain w/o dye
Ct head/brain w/dye
Ct head/brain w/dye
Ct head/brain w/dye
Ct head/brain w/o & w/dye
Ct head/brain w/o & w/dye
Ct head/brain w/o & w/dye
Ct orbit/ear/fossa w/o dye
Ct orbit/ear/fossa w/o dye
Ct orbit/ear/fossa w/o dye
Ct orbit/ear/fossa w/dye
Ct orbit/ear/fossa w/dye
Ct orbit/ear/fossa w/dye
Ct orbit/ear/fossa w/o&w/dye
Ct orbit/ear/fossa w/o&w/dye
Ct orbit/ear/fossa w/o&w/dye
Ct maxillofacial w/o dye
Ct maxillofacial w/o dye
Ct maxillofacial w/o dye
Ct maxillofacial w/dye
Ct maxillofacial w/dye
Ct maxillofacial w/dye
Ct maxillofacial w/o & w/dye
Ct maxillofacial w/o & w/dye
Ct maxillofacial w/o & w/dye
Ct soft tissue neck w/o dye
Ct soft tissue neck w/o dye
Ct soft tissue neck w/o dye
Ct soft tissue neck w/dye
Ct soft tissue neck w/dye
$16.53
$64.68
$90.91
$43.12
$47.79
$36.29
$9.70
$26.59
$94.51
$19.40
$75.10
$116.78
$43.48
$73.30
$163.14
$57.85
$105.29
$192.96
$65.04
$127.92
$185.42
$65.40
$120.02
$277.41
$70.43
$206.98
$303.64
$74.02
$229.62
$140.86
$43.48
$97.38
$169.61
$57.85
$111.75
$206.26
$64.68
$141.58
$185.42
$65.40
$120.02
$237.16
$70.79
Page 3 of 45
2016
Payment
Rate
$16.48
$60.55
$92.08
$43.71
$48.37
$36.19
$9.32
$26.87
$94.59
$19.35
$75.24
$116.44
$43.35
$73.09
$162.66
$57.68
$104.98
$192.40
$64.85
$127.55
$178.06
$65.57
$112.50
$277.67
$70.58
$207.09
$303.10
$73.81
$229.30
$140.80
$43.71
$97.09
$169.11
$57.68
$111.42
$206.37
$64.85
$141.52
$177.71
$65.57
$112.14
$237.18
$70.94
Percent
Change in
Payment Rate
-0.3%
-6.4%
1.3%
1.4%
1.2%
-0.3%
-4.0%
1.1%
0.1%
-0.3%
0.2%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-4.0%
0.3%
-6.3%
0.1%
0.2%
0.1%
-0.2%
-0.3%
-0.1%
-0.0%
0.5%
-0.3%
-0.3%
-0.3%
-0.3%
0.1%
0.3%
-0.0%
-4.2%
0.3%
-6.6%
0.0%
0.2%
CPT
Code
70491
70492
70492
70492
70496
70496
70496
70498
70498
70498
70540
70540
70540
70542
70542
70542
70543
70543
70543
70544
70544
70544
70545
70545
70545
70546
70546
70546
70547
70547
70547
70548
70548
70548
70549
70549
70549
70551
70551
70551
70552
70552
70552
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
2015
Payment
Rate
Description
Ct soft tissue neck w/dye
Ct sft tsue nck w/o & w/dye
Ct sft tsue nck w/o & w/dye
Ct sft tsue nck w/o & w/dye
Ct angiography head
Ct angiography head
Ct angiography head
Ct angiography neck
Ct angiography neck
Ct angiography neck
Mri orbit/face/neck w/o dye
Mri orbit/face/neck w/o dye
Mri orbit/face/neck w/o dye
Mri orbit/face/neck w/dye
Mri orbit/face/neck w/dye
Mri orbit/face/neck w/dye
Mri orbt/fac/nck w/o &w/dye
Mri orbt/fac/nck w/o &w/dye
Mri orbt/fac/nck w/o &w/dye
Mr angiography head w/o dye
Mr angiography head w/o dye
Mr angiography head w/o dye
Mr angiography head w/dye
Mr angiography head w/dye
Mr angiography head w/dye
Mr angiograph head w/o&w/dye
Mr angiograph head w/o&w/dye
Mr angiograph head w/o&w/dye
Mr angiography neck w/o dye
Mr angiography neck w/o dye
Mr angiography neck w/o dye
Mr angiography neck w/dye
Mr angiography neck w/dye
Mr angiography neck w/dye
Mr angiograph neck w/o&w/dye
Mr angiograph neck w/o&w/dye
Mr angiograph neck w/o&w/dye
Mri brain stem w/o dye
Mri brain stem w/o dye
Mri brain stem w/o dye
Mri brain stem w/dye
Mri brain stem w/dye
Mri brain stem w/dye
Page 4 of 45
$166.37
$279.56
$74.02
$205.54
$297.53
$89.83
$207.70
$295.73
$89.47
$206.26
$354.66
$68.27
$286.39
$405.69
$83.01
$322.68
$495.52
$109.60
$385.93
$347.84
$61.45
$286.39
$388.80
$61.09
$327.71
$575.30
$92.35
$482.95
$347.48
$61.09
$286.39
$416.47
$61.45
$355.02
$575.30
$92.35
$482.95
$231.41
$75.46
$155.95
$322.32
$91.63
$230.69
2016
Payment
Rate
$166.24
$279.10
$73.81
$205.29
$296.30
$89.21
$207.09
$294.86
$89.21
$205.65
$341.80
$68.79
$273.01
$404.14
$82.76
$321.38
$494.43
$109.28
$385.15
$334.27
$61.27
$273.01
$389.09
$61.27
$327.83
$544.94
$91.72
$453.22
$334.63
$61.62
$273.01
$414.89
$61.27
$353.62
$544.94
$91.72
$453.22
$231.81
$75.60
$156.21
$321.38
$91.00
$230.37
Percent
Change in
Payment Rate
-0.1%
-0.2%
-0.3%
-0.1%
-0.4%
-0.7%
-0.3%
-0.3%
-0.3%
-0.3%
-3.6%
0.8%
-4.7%
-0.4%
-0.3%
-0.4%
-0.2%
-0.3%
-0.2%
-3.9%
-0.3%
-4.7%
0.1%
0.3%
0.0%
-5.3%
-0.7%
-6.2%
-3.7%
0.9%
-4.7%
-0.4%
-0.3%
-0.4%
-5.3%
-0.7%
-6.2%
0.2%
0.2%
0.2%
-0.3%
-0.7%
-0.1%
CPT
Code
70553
70553
70553
70554
70554
70554
70555
70555
70555
70557
70557
70557
70558
70558
70558
70559
70559
70559
71010
71010
71010
71015
71015
71015
71020
71020
71020
71021
71021
71021
71022
71022
71022
71023
71023
71023
71030
71030
71030
71034
71034
71034
71035
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Mri brain stem w/o & w/dye
Mri brain stem w/o & w/dye
Mri brain stem w/o & w/dye
Fmri brain by tech
Fmri brain by tech
Fmri brain by tech
Fmri brain by phys/psych
Fmri brain by phys/psych
Fmri brain by phys/psych
Mri brain w/o dye
Mri brain w/o dye
Mri brain w/o dye
Mri brain w/dye
Mri brain w/dye
Mri brain w/dye
Mri brain w/o & w/dye
Mri brain w/o & w/dye
Mri brain w/o & w/dye
Chest x-ray 1 view frontal
Chest x-ray 1 view frontal
Chest x-ray 1 view frontal
Chest x-ray stereo frontal
Chest x-ray stereo frontal
Chest x-ray stereo frontal
Chest x-ray 2vw frontal&latl
Chest x-ray 2vw frontal&latl
Chest x-ray 2vw frontal&latl
Chest x-ray frnt lat lordotc
Chest x-ray frnt lat lordotc
Chest x-ray frnt lat lordotc
Chest x-ray frnt lat oblique
Chest x-ray frnt lat oblique
Chest x-ray frnt lat oblique
Chest x-ray and fluoroscopy
Chest x-ray and fluoroscopy
Chest x-ray and fluoroscopy
Chest x-ray 4/> views
Chest x-ray 4/> views
Chest x-ray 4/> views
Chest x-ray&fluoro 4/> views
Chest x-ray&fluoro 4/> views
Chest x-ray&fluoro 4/> views
Chest x-ray special views
$380.18
$117.14
$263.03
$454.56
$109.96
$344.60
$0.00
$133.67
$0.00
$0.00
$153.80
$0.00
$0.00
$169.97
$0.00
$0.00
$170.32
$0.00
$22.64
$9.34
$13.30
$27.67
$11.14
$16.53
$28.03
$11.14
$16.89
$34.14
$14.01
$20.12
$42.04
$16.89
$25.15
$63.96
$19.76
$44.20
$41.68
$15.81
$25.87
$84.80
$23.72
$61.09
$32.70
Page 5 of 45
2016
Payment
Rate
$379.78
$117.16
$262.62
$453.58
$108.56
$345.02
$0.00
$128.98
$0.00
$0.00
$149.04
$0.00
$0.00
$164.09
$0.00
$0.00
$165.17
$0.00
$22.57
$9.32
$13.26
$27.95
$11.11
$16.84
$27.95
$11.11
$16.84
$34.04
$13.97
$20.06
$41.92
$16.84
$25.08
$63.77
$19.35
$44.43
$41.92
$16.12
$25.80
$83.48
$23.65
$59.83
$32.96
Percent
Change in
Payment Rate
-0.1%
0.0%
-0.2%
-0.2%
-1.3%
0.1%
-3.5%
-3.1%
-3.5%
-3.0%
-0.3%
-0.3%
-0.3%
1.0%
-0.3%
1.9%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-2.1%
0.5%
0.6%
2.0%
-0.3%
-1.6%
-0.3%
-2.1%
0.8%
CPT
Code
71035
71035
71100
71100
71100
71101
71101
71101
71110
71110
71110
71111
71111
71111
71120
71120
71120
71130
71130
71130
71250
71250
71250
71260
71260
71260
71270
71270
71270
71275
71275
71275
71550
71550
71550
71551
71551
71551
71552
71552
71552
71555
71555
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
2015
Payment
Rate
Description
Chest x-ray special views
Chest x-ray special views
X-ray exam ribs uni 2 views
X-ray exam ribs uni 2 views
X-ray exam ribs uni 2 views
X-ray exam unilat ribs/chest
X-ray exam unilat ribs/chest
X-ray exam unilat ribs/chest
X-ray exam ribs bil 3 views
X-ray exam ribs bil 3 views
X-ray exam ribs bil 3 views
X-ray exam ribs/chest4/> vws
X-ray exam ribs/chest4/> vws
X-ray exam ribs/chest4/> vws
X-ray exam breastbone 2/>vws
X-ray exam breastbone 2/>vws
X-ray exam breastbone 2/>vws
X-ray strenoclavic jt 3/>vws
X-ray strenoclavic jt 3/>vws
X-ray strenoclavic jt 3/>vws
Ct thorax w/o dye
Ct thorax w/o dye
Ct thorax w/o dye
Ct thorax w/dye
Ct thorax w/dye
Ct thorax w/dye
Ct thorax w/o & w/dye
Ct thorax w/o & w/dye
Ct thorax w/o & w/dye
Ct angiography chest
Ct angiography chest
Ct angiography chest
Mri chest w/o dye
Mri chest w/o dye
Mri chest w/o dye
Mri chest w/dye
Mri chest w/dye
Mri chest w/dye
Mri chest w/o & w/dye
Mri chest w/o & w/dye
Mri chest w/o & w/dye
Mri angio chest w or w/o dye
Mri angio chest w or w/o dye
Page 6 of 45
$9.34
$23.36
$30.54
$11.50
$19.04
$36.29
$13.65
$22.64
$37.37
$14.01
$23.36
$47.43
$16.53
$30.90
$29.47
$10.42
$19.04
$36.29
$11.86
$24.43
$172.12
$52.10
$120.02
$230.69
$63.60
$167.09
$276.69
$70.43
$206.26
$302.20
$93.43
$208.77
$360.77
$74.38
$286.39
$461.03
$88.76
$372.27
$584.28
$116.42
$467.85
$401.02
$91.99
2016
Payment
Rate
$9.32
$23.65
$32.96
$11.46
$21.50
$36.54
$13.97
$22.57
$37.62
$13.97
$23.65
$48.01
$16.84
$31.17
$29.74
$10.39
$19.35
$36.19
$11.46
$24.72
$164.45
$52.31
$112.14
$230.73
$63.77
$166.96
$276.59
$70.58
$206.01
$301.31
$92.79
$208.52
$347.53
$74.52
$273.01
$460.75
$88.14
$372.61
$568.59
$115.37
$453.22
$399.48
$91.36
Percent
Change in
Payment Rate
-0.3%
1.2%
7.9%
-0.3%
12.9%
0.7%
2.3%
-0.3%
0.7%
-0.3%
1.2%
1.2%
1.9%
0.9%
0.9%
-0.3%
1.6%
-0.3%
-3.3%
1.2%
-4.5%
0.4%
-6.6%
0.0%
0.3%
-0.1%
-0.0%
0.2%
-0.1%
-0.3%
-0.7%
-0.1%
-3.7%
0.2%
-4.7%
-0.1%
-0.7%
0.1%
-2.7%
-0.9%
-3.1%
-0.4%
-0.7%
CPT
Code
71555
72020
72020
72020
72040
72040
72040
72050
72050
72050
72052
72052
72052
72070
72070
72070
72072
72072
72072
72074
72074
72074
72080
72080
72080
72081
72081
72081
72082
72082
72082
72083
72083
72083
72084
72084
72084
72100
72100
72100
72110
72110
72110
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Mri angio chest w or w/o dye
X-ray exam of spine 1 view
X-ray exam of spine 1 view
X-ray exam of spine 1 view
X-ray exam neck spine 2-3 vw
X-ray exam neck spine 2-3 vw
X-ray exam neck spine 2-3 vw
X-ray exam neck spine 4/5vws
X-ray exam neck spine 4/5vws
X-ray exam neck spine 4/5vws
X-ray exam neck spine 6/>vws
X-ray exam neck spine 6/>vws
X-ray exam neck spine 6/>vws
X-ray exam thorac spine 2vws
X-ray exam thorac spine 2vws
X-ray exam thorac spine 2vws
X-ray exam thorac spine 3vws
X-ray exam thorac spine 3vws
X-ray exam thorac spine 3vws
X-ray exam thorac spine4/>vw
X-ray exam thorac spine4/>vw
X-ray exam thorac spine4/>vw
X-ray exam thoracolmb 2/> vw
X-ray exam trunk spine 2 vws
X-ray exam trunk spine 2 vws
X-ray exam entire spi 1 vw
X-ray exam entire spi 1 vw
X-ray exam entire spi 1 vw
X-ray exam entire spi 2/3 vw
X-ray exam entire spi 2/3 vw
X-ray exam entire spi 2/3 vw
X-ray exam entire spi 4/5 vw
X-ray exam entire spi 4/5 vw
X-ray exam entire spi 4/5 vw
X-ray exam entire spi 6/> vw
X-ray exam entire spi 6/> vw
X-ray exam entire spi 6/> vw
X-ray exam l-s spine 2/3 vws
X-ray exam l-s spine 2/3 vws
X-ray exam l-s spine 2/3 vws
X-ray exam l-2 spine 4/>vws
X-ray exam l-2 spine 4/>vws
X-ray exam l-2 spine 4/>vws
$309.03
$21.92
$7.91
$14.01
$33.42
$11.86
$21.56
$44.92
$16.17
$28.75
$56.42
$19.04
$37.37
$31.62
$11.86
$19.76
$34.50
$11.14
$23.36
$39.17
$11.14
$28.03
$33.78
$12.22
$21.56
$35.21
$11.86
$23.36
$49.23
$16.53
$32.70
Page 7 of 45
2016
Payment
Rate
$308.12
$22.21
$7.88
$14.33
$33.32
$11.46
$21.86
$45.14
$16.12
$29.02
$56.61
$18.63
$37.98
$34.04
$11.46
$22.57
$34.75
$11.11
$23.65
$39.41
$11.11
$28.30
$30.81
$11.11
$19.71
$39.05
$13.61
$25.44
$62.70
$16.48
$46.22
$68.07
$17.91
$50.16
$80.97
$20.78
$60.19
$35.11
$11.46
$23.65
$49.08
$16.12
$32.96
Percent
Change in
Payment Rate
-0.3%
1.3%
-0.3%
2.3%
-0.3%
-3.3%
1.4%
0.5%
-0.3%
1.0%
0.3%
-2.2%
1.6%
7.6%
-3.3%
14.2%
0.7%
-0.3%
1.2%
0.6%
-0.3%
1.0%
-8.8%
-9.1%
-8.6%
-0.3%
-3.3%
1.2%
-0.3%
-2.5%
0.8%
CPT
Code
72114
72114
72114
72120
72120
72120
72125
72125
72125
72126
72126
72126
72127
72127
72127
72128
72128
72128
72129
72129
72129
72130
72130
72130
72131
72131
72131
72132
72132
72132
72133
72133
72133
72141
72141
72141
72142
72142
72142
72146
72146
72146
72147
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
X-ray exam l-s spine bending
X-ray exam l-s spine bending
X-ray exam l-s spine bending
X-ray bend only l-s spine
X-ray bend only l-s spine
X-ray bend only l-s spine
Ct neck spine w/o dye
Ct neck spine w/o dye
Ct neck spine w/o dye
Ct neck spine w/dye
Ct neck spine w/dye
Ct neck spine w/dye
Ct neck spine w/o & w/dye
Ct neck spine w/o & w/dye
Ct neck spine w/o & w/dye
Ct chest spine w/o dye
Ct chest spine w/o dye
Ct chest spine w/o dye
Ct chest spine w/dye
Ct chest spine w/dye
Ct chest spine w/dye
Ct chest spine w/o & w/dye
Ct chest spine w/o & w/dye
Ct chest spine w/o & w/dye
Ct lumbar spine w/o dye
Ct lumbar spine w/o dye
Ct lumbar spine w/o dye
Ct lumbar spine w/dye
Ct lumbar spine w/dye
Ct lumbar spine w/dye
Ct lumbar spine w/o & w/dye
Ct lumbar spine w/o & w/dye
Ct lumbar spine w/o & w/dye
Mri neck spine w/o dye
Mri neck spine w/o dye
Mri neck spine w/o dye
Mri neck spine w/dye
Mri neck spine w/dye
Mri neck spine w/dye
Mri chest spine w/o dye
Mri chest spine w/o dye
Mri chest spine w/o dye
Mri chest spine w/dye
$62.88
$17.25
$45.64
$40.60
$12.22
$28.39
$174.64
$54.62
$120.02
$230.69
$62.52
$168.17
$272.02
$64.68
$207.34
$171.04
$51.03
$120.02
$230.69
$62.17
$168.53
$272.38
$64.68
$207.70
$171.04
$51.03
$120.02
$229.97
$62.52
$167.45
$272.38
$65.04
$207.34
$224.58
$75.46
$149.12
$325.92
$91.63
$234.29
$224.58
$75.46
$149.12
$323.76
Page 8 of 45
2016
Payment
Rate
$62.70
$16.84
$45.86
$40.49
$11.46
$29.02
$166.96
$54.82
$112.14
$230.37
$62.34
$168.03
$272.29
$64.85
$207.44
$163.38
$51.23
$112.14
$230.73
$62.34
$168.39
$274.08
$64.85
$209.23
$163.38
$51.23
$112.14
$229.66
$62.34
$167.32
$271.93
$64.85
$207.09
$225.00
$75.96
$149.04
$326.75
$91.72
$235.03
$225.36
$75.96
$149.40
$323.17
Percent
Change in
Payment Rate
-0.3%
-2.4%
0.5%
-0.3%
-6.2%
2.2%
-4.4%
0.4%
-6.6%
-0.1%
-0.3%
-0.1%
0.1%
0.3%
0.1%
-4.5%
0.4%
-6.6%
0.0%
0.3%
-0.1%
0.6%
0.3%
0.7%
-4.5%
0.4%
-6.6%
-0.1%
-0.3%
-0.1%
-0.2%
-0.3%
-0.1%
0.2%
0.7%
-0.1%
0.3%
0.1%
0.3%
0.3%
0.7%
0.2%
-0.2%
CPT
Code
72147
72147
72148
72148
72148
72149
72149
72149
72156
72156
72156
72157
72157
72157
72158
72158
72158
72159
72159
72159
72170
72170
72170
72190
72190
72190
72191
72191
72191
72192
72192
72192
72193
72193
72193
72194
72194
72194
72195
72195
72195
72196
72196
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
2015
Payment
Rate
Description
Mri chest spine w/dye
Mri chest spine w/dye
Mri lumbar spine w/o dye
Mri lumbar spine w/o dye
Mri lumbar spine w/o dye
Mri lumbar spine w/dye
Mri lumbar spine w/dye
Mri lumbar spine w/dye
Mri neck spine w/o & w/dye
Mri neck spine w/o & w/dye
Mri neck spine w/o & w/dye
Mri chest spine w/o & w/dye
Mri chest spine w/o & w/dye
Mri chest spine w/o & w/dye
Mri lumbar spine w/o & w/dye
Mri lumbar spine w/o & w/dye
Mri lumbar spine w/o & w/dye
Mr angio spine w/o&w/dye
Mr angio spine w/o&w/dye
Mr angio spine w/o&w/dye
X-ray exam of pelvis
X-ray exam of pelvis
X-ray exam of pelvis
X-ray exam of pelvis
X-ray exam of pelvis
X-ray exam of pelvis
Ct angiograph pelv w/o&w/dye
Ct angiograph pelv w/o&w/dye
Ct angiograph pelv w/o&w/dye
Ct pelvis w/o dye
Ct pelvis w/o dye
Ct pelvis w/o dye
Ct pelvis w/dye
Ct pelvis w/dye
Ct pelvis w/dye
Ct pelvis w/o & w/dye
Ct pelvis w/o & w/dye
Ct pelvis w/o & w/dye
Mri pelvis w/o dye
Mri pelvis w/o dye
Mri pelvis w/o dye
Mri pelvis w/dye
Mri pelvis w/dye
Page 9 of 45
$91.63
$232.13
$223.51
$75.82
$147.69
$321.96
$91.63
$230.33
$382.33
$117.14
$265.19
$383.41
$117.86
$265.55
$381.25
$117.86
$263.39
$420.78
$93.43
$327.35
$27.67
$9.34
$18.33
$38.45
$11.50
$26.95
$306.51
$92.35
$214.16
$147.33
$55.70
$91.63
$227.10
$59.29
$167.81
$261.96
$62.17
$199.79
$361.13
$74.74
$286.39
$414.31
$89.12
2016
Payment
Rate
$91.00
$232.16
$223.92
$75.96
$147.97
$322.45
$91.36
$231.09
$381.57
$117.16
$264.41
$381.93
$117.16
$264.77
$380.49
$117.16
$263.34
$418.83
$92.08
$326.75
$31.89
$8.96
$22.93
$38.34
$11.11
$27.23
$307.05
$92.08
$214.97
$146.54
$55.53
$91.00
$227.15
$59.47
$167.67
$261.54
$61.98
$199.56
$347.53
$74.52
$273.01
$413.45
$88.49
Percent
Change in
Payment Rate
-0.7%
0.0%
0.2%
0.2%
0.2%
0.2%
-0.3%
0.3%
-0.2%
0.0%
-0.3%
-0.4%
-0.6%
-0.3%
-0.2%
-0.6%
-0.0%
-0.5%
-1.4%
-0.2%
15.2%
-4.1%
25.1%
-0.3%
-3.4%
1.0%
0.2%
-0.3%
0.4%
-0.5%
-0.3%
-0.7%
0.0%
0.3%
-0.1%
-0.2%
-0.3%
-0.1%
-3.8%
-0.3%
-4.7%
-0.2%
-0.7%
CPT
Code
72196
72197
72197
72197
72198
72198
72198
72200
72200
72200
72202
72202
72202
72220
72220
72220
72240
72240
72240
72255
72255
72255
72265
72265
72265
72270
72270
72270
72275
72275
72275
72285
72285
72285
72295
72295
72295
73000
73000
73000
73010
73010
73010
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Mri pelvis w/dye
Mri pelvis w/o & w/dye
Mri pelvis w/o & w/dye
Mri pelvis w/o & w/dye
Mr angio pelvis w/o & w/dye
Mr angio pelvis w/o & w/dye
Mr angio pelvis w/o & w/dye
X-ray exam si joints
X-ray exam si joints
X-ray exam si joints
X-ray exam si joints 3/> vws
X-ray exam si joints 3/> vws
X-ray exam si joints 3/> vws
X-ray exam sacrum tailbone
X-ray exam sacrum tailbone
X-ray exam sacrum tailbone
Myelography neck spine
Myelography neck spine
Myelography neck spine
Myelography thoracic spine
Myelography thoracic spine
Myelography thoracic spine
Myelography l-s spine
Myelography l-s spine
Myelography l-s spine
Myelogphy 2/> spine regions
Myelogphy 2/> spine regions
Myelogphy 2/> spine regions
Epidurography
Epidurography
Epidurography
Discography cerv/thor spine
Discography cerv/thor spine
Discography cerv/thor spine
X-ray of lower spine disk
X-ray of lower spine disk
X-ray of lower spine disk
X-ray exam of collar bone
X-ray exam of collar bone
X-ray exam of collar bone
X-ray exam of shoulder blade
X-ray exam of shoulder blade
X-ray exam of shoulder blade
$325.20
$509.90
$116.42
$393.47
$404.97
$91.63
$313.34
$28.39
$8.98
$19.40
$33.06
$9.70
$23.36
$28.03
$8.98
$19.04
$99.18
$47.07
$52.10
$98.46
$47.07
$51.38
$92.71
$42.76
$49.95
$128.28
$68.27
$60.01
$116.42
$40.25
$76.18
$115.35
$62.52
$52.82
$98.82
$43.84
$54.98
$28.03
$8.98
$19.04
$30.18
$9.70
$20.48
Page 10 of 45
2016
Payment
Rate
$324.96
$508.04
$115.37
$392.67
$402.35
$91.00
$311.34
$28.66
$8.96
$19.71
$32.96
$9.67
$23.29
$28.30
$8.96
$19.35
$98.53
$46.58
$51.95
$98.17
$47.29
$50.88
$92.79
$42.64
$50.16
$128.26
$68.43
$59.83
$116.80
$40.13
$76.67
$115.72
$62.34
$53.38
$99.96
$44.43
$55.53
$27.59
$8.60
$18.99
$30.10
$9.32
$20.78
Percent
Change in
Payment Rate
-0.1%
-0.4%
-0.9%
-0.2%
-0.6%
-0.7%
-0.6%
1.0%
-0.3%
1.6%
-0.3%
-0.3%
-0.3%
1.0%
-0.3%
1.6%
-0.7%
-1.1%
-0.3%
-0.3%
0.5%
-1.0%
0.1%
-0.3%
0.4%
-0.0%
0.2%
-0.3%
0.3%
-0.3%
0.6%
0.3%
-0.3%
1.1%
1.2%
1.3%
1.0%
-1.6%
-4.3%
-0.3%
-0.3%
-4.0%
1.5%
CPT
Code
73020
73020
73020
73030
73030
73030
73040
73040
73040
73050
73050
73050
73060
73060
73060
73070
73070
73070
73080
73080
73080
73085
73085
73085
73090
73090
73090
73092
73092
73092
73100
73100
73100
73110
73110
73110
73115
73115
73115
73120
73120
73120
73130
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
X-ray exam of shoulder
X-ray exam of shoulder
X-ray exam of shoulder
X-ray exam of shoulder
X-ray exam of shoulder
X-ray exam of shoulder
Contrast x-ray of shoulder
Contrast x-ray of shoulder
Contrast x-ray of shoulder
X-ray exam of shoulders
X-ray exam of shoulders
X-ray exam of shoulders
X-ray exam of humerus
X-ray exam of humerus
X-ray exam of humerus
X-ray exam of elbow
X-ray exam of elbow
X-ray exam of elbow
X-ray exam of elbow
X-ray exam of elbow
X-ray exam of elbow
Contrast x-ray of elbow
Contrast x-ray of elbow
Contrast x-ray of elbow
X-ray exam of forearm
X-ray exam of forearm
X-ray exam of forearm
X-ray exam of arm infant
X-ray exam of arm infant
X-ray exam of arm infant
X-ray exam of wrist
X-ray exam of wrist
X-ray exam of wrist
X-ray exam of wrist
X-ray exam of wrist
X-ray exam of wrist
Contrast x-ray of wrist
Contrast x-ray of wrist
Contrast x-ray of wrist
X-ray exam of hand
X-ray exam of hand
X-ray exam of hand
X-ray exam of hand
$23.36
$8.26
$15.09
$29.11
$10.06
$19.04
$101.33
$28.39
$72.95
$35.93
$11.14
$24.79
$26.95
$9.34
$17.61
$27.67
$8.62
$19.04
$31.62
$9.34
$22.28
$99.18
$29.11
$70.07
$25.87
$8.62
$17.25
$27.31
$8.26
$19.04
$29.47
$8.98
$20.48
$35.57
$9.34
$26.23
$107.80
$29.11
$78.69
$26.23
$8.62
$17.61
$30.54
Page 11 of 45
2016
Payment
Rate
$22.93
$7.88
$15.05
$29.02
$9.67
$19.35
$100.68
$27.95
$72.73
$35.83
$10.75
$25.08
$29.02
$8.60
$20.42
$27.59
$8.24
$19.35
$31.17
$8.96
$22.21
$98.17
$29.38
$68.79
$25.80
$8.60
$17.20
$27.23
$8.24
$18.99
$29.38
$8.60
$20.78
$35.47
$8.96
$26.51
$107.48
$29.02
$78.46
$26.15
$8.60
$17.56
$30.81
Percent
Change in
Payment Rate
-1.8%
-4.6%
-0.3%
-0.3%
-3.9%
1.6%
-0.6%
-1.6%
-0.3%
-0.3%
-3.5%
1.2%
7.7%
-8.0%
16.0%
-0.3%
-4.4%
1.6%
-1.4%
-4.1%
-0.3%
-1.0%
0.9%
-1.8%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-4.3%
1.5%
-0.3%
-4.1%
1.1%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
0.9%
CPT
Code
73130
73130
73140
73140
73140
73200
73200
73200
73201
73201
73201
73202
73202
73202
73206
73206
73206
73218
73218
73218
73219
73219
73219
73220
73220
73220
73221
73221
73221
73222
73222
73222
73223
73223
73223
73225
73225
73225
73501
73501
73501
73502
73502
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
2015
Payment
Rate
Description
X-ray exam of hand
X-ray exam of hand
X-ray exam of finger(s)
X-ray exam of finger(s)
X-ray exam of finger(s)
Ct upper extremity w/o dye
Ct upper extremity w/o dye
Ct upper extremity w/o dye
Ct upper extremity w/dye
Ct upper extremity w/dye
Ct upper extremity w/dye
Ct uppr extremity w/o&w/dye
Ct uppr extremity w/o&w/dye
Ct uppr extremity w/o&w/dye
Ct angio upr extrm w/o&w/dye
Ct angio upr extrm w/o&w/dye
Ct angio upr extrm w/o&w/dye
Mri upper extremity w/o dye
Mri upper extremity w/o dye
Mri upper extremity w/o dye
Mri upper extremity w/dye
Mri upper extremity w/dye
Mri upper extremity w/dye
Mri uppr extremity w/o&w/dye
Mri uppr extremity w/o&w/dye
Mri uppr extremity w/o&w/dye
Mri joint upr extrem w/o dye
Mri joint upr extrem w/o dye
Mri joint upr extrem w/o dye
Mri joint upr extrem w/dye
Mri joint upr extrem w/dye
Mri joint upr extrem w/dye
Mri joint upr extr w/o&w/dye
Mri joint upr extr w/o&w/dye
Mri joint upr extr w/o&w/dye
Mr angio upr extr w/o&w/dye
Mr angio upr extr w/o&w/dye
Mr angio upr extr w/o&w/dye
X-ray exam hip uni 1 view
X-ray exam hip uni 1 view
X-ray exam hip uni 1 view
X-ray exam hip uni 2-3 views
X-ray exam hip uni 2-3 views
Page 12 of 45
$8.98
$21.56
$31.26
$7.19
$24.08
$171.04
$51.03
$120.02
$223.87
$59.29
$164.58
$279.56
$62.17
$217.40
$328.79
$91.99
$236.80
$355.02
$68.63
$286.39
$406.77
$83.73
$323.04
$503.07
$110.32
$392.75
$237.16
$69.71
$167.45
$381.25
$83.37
$297.89
$472.53
$110.32
$362.21
$406.77
$87.32
$319.45
2016
Payment
Rate
$8.96
$21.86
$31.53
$7.17
$24.36
$163.38
$51.23
$112.14
$223.92
$59.47
$164.45
$279.10
$62.34
$216.76
$327.83
$91.72
$236.11
$342.16
$69.15
$273.01
$406.29
$82.76
$323.53
$502.67
$109.99
$392.67
$237.54
$69.51
$168.03
$380.13
$83.12
$297.01
$471.85
$109.99
$361.86
$407.36
$87.42
$319.94
$30.10
$9.67
$20.42
$41.56
$11.46
Percent
Change in
Payment Rate
-0.3%
1.4%
0.9%
-0.3%
1.2%
-4.5%
0.4%
-6.6%
0.0%
0.3%
-0.1%
-0.2%
0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-3.6%
0.8%
-4.7%
-0.1%
-1.1%
0.1%
-0.1%
-0.3%
-0.0%
0.2%
-0.3%
0.3%
-0.3%
-0.3%
-0.3%
-0.1%
-0.3%
-0.1%
0.1%
0.1%
0.2%
CPT
Code
73502
73503
73503
73503
73521
73521
73521
73522
73522
73522
73523
73523
73523
73525
73525
73525
73551
73551
73551
73552
73552
73552
73560
73560
73560
73562
73562
73562
73564
73564
73564
73565
73565
73565
73580
73580
73580
73590
73590
73590
73592
73592
73592
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
X-ray exam hip uni 2-3 views
X-ray exam hip uni 4/> views
X-ray exam hip uni 4/> views
X-ray exam hip uni 4/> views
X-ray exam hips bi 2 views
X-ray exam hips bi 2 views
X-ray exam hips bi 2 views
X-ray exam hips bi 3-4 views
X-ray exam hips bi 3-4 views
X-ray exam hips bi 3-4 views
X-ray exam hips bi 5/> views
X-ray exam hips bi 5/> views
X-ray exam hips bi 5/> views
Contrast x-ray of hip
Contrast x-ray of hip
Contrast x-ray of hip
X-ray exam of femur 1
X-ray exam of femur 1
X-ray exam of femur 1
X-ray exam of femur 2/>
X-ray exam of femur 2/>
X-ray exam of femur 2/>
X-ray exam of knee 1 or 2
X-ray exam of knee 1 or 2
X-ray exam of knee 1 or 2
X-ray exam of knee 3
X-ray exam of knee 3
X-ray exam of knee 3
X-ray exam knee 4 or more
X-ray exam knee 4 or more
X-ray exam knee 4 or more
X-ray exam of knees
X-ray exam of knees
X-ray exam of knees
Contrast x-ray of knee joint
Contrast x-ray of knee joint
Contrast x-ray of knee joint
X-ray exam of lower leg
X-ray exam of lower leg
X-ray exam of lower leg
X-ray exam of leg infant
X-ray exam of leg infant
X-ray exam of leg infant
$102.41
$29.47
$72.95
$29.47
$9.70
$19.76
$34.50
$10.06
$24.43
$40.25
$12.22
$28.03
$33.06
$9.70
$23.36
$115.71
$28.75
$86.96
$26.59
$8.98
$17.61
$27.31
$8.26
$19.04
Page 13 of 45
2016
Payment
Rate
$30.10
$51.95
$14.69
$37.26
$40.13
$11.82
$28.30
$49.08
$15.41
$33.68
$56.97
$16.48
$40.49
$102.47
$29.38
$73.09
$27.95
$8.60
$19.35
$32.60
$9.67
$22.93
$31.17
$8.60
$22.57
$35.83
$9.67
$26.15
$39.77
$11.46
$28.30
$36.19
$8.96
$27.23
$116.08
$29.02
$87.06
$28.66
$8.60
$20.06
$27.95
$8.24
$19.71
Percent
Change in
Payment Rate
0.1%
-0.3%
0.2%
5.8%
-11.4%
14.2%
3.9%
-3.9%
7.0%
-1.2%
-6.2%
1.0%
9.5%
-7.7%
16.6%
0.3%
1.0%
0.1%
7.8%
-4.3%
13.9%
2.3%
-0.3%
3.5%
CPT
Code
73600
73600
73600
73610
73610
73610
73615
73615
73615
73620
73620
73620
73630
73630
73630
73650
73650
73650
73660
73660
73660
73700
73700
73700
73701
73701
73701
73702
73702
73702
73706
73706
73706
73718
73718
73718
73719
73719
73719
73720
73720
73720
73721
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
X-ray exam of ankle
X-ray exam of ankle
X-ray exam of ankle
X-ray exam of ankle
X-ray exam of ankle
X-ray exam of ankle
Contrast x-ray of ankle
Contrast x-ray of ankle
Contrast x-ray of ankle
X-ray exam of foot
X-ray exam of foot
X-ray exam of foot
X-ray exam of foot
X-ray exam of foot
X-ray exam of foot
X-ray exam of heel
X-ray exam of heel
X-ray exam of heel
X-ray exam of toe(s)
X-ray exam of toe(s)
X-ray exam of toe(s)
Ct lower extremity w/o dye
Ct lower extremity w/o dye
Ct lower extremity w/o dye
Ct lower extremity w/dye
Ct lower extremity w/dye
Ct lower extremity w/dye
Ct lwr extremity w/o&w/dye
Ct lwr extremity w/o&w/dye
Ct lwr extremity w/o&w/dye
Ct angio lwr extr w/o&w/dye
Ct angio lwr extr w/o&w/dye
Ct angio lwr extr w/o&w/dye
Mri lower extremity w/o dye
Mri lower extremity w/o dye
Mri lower extremity w/o dye
Mri lower extremity w/dye
Mri lower extremity w/dye
Mri lower extremity w/dye
Mri lwr extremity w/o&w/dye
Mri lwr extremity w/o&w/dye
Mri lwr extremity w/o&w/dye
Mri jnt of lwr extre w/o dye
$27.31
$8.62
$18.69
$31.62
$9.34
$22.28
$99.54
$29.82
$69.71
$25.87
$7.91
$17.97
$29.11
$8.62
$20.48
$26.95
$8.26
$18.69
$28.03
$6.83
$21.20
$171.04
$51.03
$120.02
$227.10
$59.29
$167.81
$274.89
$61.45
$213.45
$353.59
$96.30
$257.28
$355.02
$68.63
$286.39
$407.49
$83.01
$324.48
$506.30
$110.32
$395.99
$236.80
Page 14 of 45
2016
Payment
Rate
$30.10
$8.60
$21.50
$31.53
$8.96
$22.57
$106.05
$29.38
$76.67
$26.15
$7.88
$18.27
$29.38
$8.60
$20.78
$27.23
$8.24
$18.99
$28.30
$6.81
$21.50
$163.38
$51.23
$112.14
$227.51
$59.47
$168.03
$276.23
$61.98
$214.25
$332.84
$96.38
$236.46
$342.16
$69.15
$273.01
$406.29
$82.76
$323.53
$505.17
$109.63
$395.54
$237.90
Percent
Change in
Payment Rate
10.2%
-0.3%
15.0%
-0.3%
-4.1%
1.3%
6.5%
-1.5%
10.0%
1.1%
-0.3%
1.7%
0.9%
-0.3%
1.5%
1.0%
-0.3%
1.6%
1.0%
-0.3%
1.4%
-4.5%
0.4%
-6.6%
0.2%
0.3%
0.1%
0.5%
0.9%
0.4%
-5.9%
0.1%
-8.1%
-3.6%
0.8%
-4.7%
-0.3%
-0.3%
-0.3%
-0.2%
-0.6%
-0.1%
0.5%
CPT
Code
73721
73721
73722
73722
73722
73723
73723
73723
73725
73725
73725
74000
74000
74000
74010
74010
74010
74020
74020
74020
74022
74022
74022
74150
74150
74150
74160
74160
74160
74170
74170
74170
74174
74174
74174
74175
74175
74175
74176
74176
74176
74177
74177
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
2015
Payment
Rate
Description
Mri jnt of lwr extre w/o dye
Mri jnt of lwr extre w/o dye
Mri joint of lwr extr w/dye
Mri joint of lwr extr w/dye
Mri joint of lwr extr w/dye
Mri joint lwr extr w/o&w/dye
Mri joint lwr extr w/o&w/dye
Mri joint lwr extr w/o&w/dye
Mr ang lwr ext w or w/o dye
Mr ang lwr ext w or w/o dye
Mr ang lwr ext w or w/o dye
X-ray exam of abdomen
X-ray exam of abdomen
X-ray exam of abdomen
X-ray exam of abdomen
X-ray exam of abdomen
X-ray exam of abdomen
X-ray exam of abdomen
X-ray exam of abdomen
X-ray exam of abdomen
X-ray exam series abdomen
X-ray exam series abdomen
X-ray exam series abdomen
Ct abdomen w/o dye
Ct abdomen w/o dye
Ct abdomen w/o dye
Ct abdomen w/dye
Ct abdomen w/dye
Ct abdomen w/dye
Ct abdomen w/o & w/dye
Ct abdomen w/o & w/dye
Ct abdomen w/o & w/dye
Ct angio abd&pelv w/o&w/dye
Ct angio abd&pelv w/o&w/dye
Ct angio abd&pelv w/o&w/dye
Ct angio abdom w/o & w/dye
Ct angio abdom w/o & w/dye
Ct angio abdom w/o & w/dye
Ct abd & pelvis w/o contrast
Ct abd & pelvis w/o contrast
Ct abd & pelvis w/o contrast
Ct abd & pelv w/contrast
Ct abd & pelv w/contrast
Page 15 of 45
$69.35
$167.45
$384.49
$83.73
$300.76
$474.68
$110.32
$364.37
$406.05
$92.35
$313.70
$23.72
$9.34
$14.37
$35.21
$11.86
$23.36
$37.37
$13.65
$23.72
$44.20
$16.17
$28.03
$150.92
$60.73
$90.19
$232.13
$65.04
$167.09
$264.11
$71.51
$192.60
$392.03
$112.83
$279.20
$309.03
$92.71
$216.32
$201.95
$89.47
$112.47
$314.06
$93.79
2016
Payment
Rate
$69.51
$168.39
$384.08
$83.12
$300.95
$472.93
$109.63
$363.29
$403.42
$91.72
$311.70
$23.65
$9.32
$14.33
$35.47
$11.82
$23.65
$37.62
$13.97
$23.65
$44.78
$16.48
$28.30
$150.48
$60.91
$89.57
$231.81
$64.85
$166.96
$263.69
$71.66
$192.04
$390.52
$111.78
$278.74
$308.48
$92.44
$216.04
$200.99
$88.85
$112.14
$313.14
$93.15
Percent
Change in
Payment Rate
0.2%
0.6%
-0.1%
-0.7%
0.1%
-0.4%
-0.6%
-0.3%
-0.6%
-0.7%
-0.6%
-0.3%
-0.3%
-0.3%
0.7%
-0.3%
1.2%
0.7%
2.3%
-0.3%
1.3%
1.9%
1.0%
-0.3%
0.3%
-0.7%
-0.1%
-0.3%
-0.1%
-0.2%
0.2%
-0.3%
-0.4%
-0.9%
-0.2%
-0.2%
-0.3%
-0.1%
-0.5%
-0.7%
-0.3%
-0.3%
-0.7%
CPT
Code
74177
74178
74178
74178
74181
74181
74181
74182
74182
74182
74183
74183
74183
74185
74185
74185
74190
74190
74190
74210
74210
74210
74220
74220
74220
74230
74230
74230
74235
74235
74235
74240
74240
74240
74241
74241
74241
74245
74245
74245
74246
74246
74246
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
2015
Payment
Rate
Description
Ct abd & pelv w/contrast
Ct abd & pelv 1/> regns
Ct abd & pelv 1/> regns
Ct abd & pelv 1/> regns
Mri abdomen w/o dye
Mri abdomen w/o dye
Mri abdomen w/o dye
Mri abdomen w/dye
Mri abdomen w/dye
Mri abdomen w/dye
Mri abdomen w/o & w/dye
Mri abdomen w/o & w/dye
Mri abdomen w/o & w/dye
Mri angio abdom w orw/o dye
Mri angio abdom w orw/o dye
Mri angio abdom w orw/o dye
X-ray exam of peritoneum
X-ray exam of peritoneum
X-ray exam of peritoneum
Contrst x-ray exam of throat
Contrst x-ray exam of throat
Contrst x-ray exam of throat
Contrast x-ray esophagus
Contrast x-ray esophagus
Contrast x-ray esophagus
Cine/vid x-ray throat/esoph
Cine/vid x-ray throat/esoph
Cine/vid x-ray throat/esoph
Remove esophagus obstruction
Remove esophagus obstruction
Remove esophagus obstruction
X-ray upper gi delay w/o kub
X-ray upper gi delay w/o kub
X-ray upper gi delay w/o kub
X-ray upper gi delay w/kub
X-rayupper gi delay w/kub
X-rayupper gi delay w/kub
X-ray upper gi&small intest
X-ray upper gi&small intest
X-ray upper gi&small intest
Contrst x-ray uppr gi tract
Contrst x-ray uppr gi tract
Contrst x-ray uppr gi tract
Page 16 of 45
$220.27
$355.38
$103.13
$252.25
$334.90
$74.38
$260.52
$458.15
$88.76
$369.40
$510.97
$116.42
$394.55
$406.05
$91.63
$314.42
$0.00
$24.43
$0.00
$77.98
$18.33
$59.65
$89.12
$23.72
$65.40
$129.00
$27.31
$101.69
$0.00
$64.68
$0.00
$114.63
$35.93
$78.69
$118.22
$35.21
$83.01
$172.48
$46.71
$125.77
$129.00
$36.29
$92.71
2016
Payment
Rate
$219.98
$354.70
$102.47
$252.23
$334.63
$74.52
$260.11
$456.45
$88.49
$367.95
$509.11
$115.37
$393.75
$405.21
$91.36
$313.85
$0.00
$24.00
$0.00
$78.10
$18.27
$59.83
$89.21
$23.65
$65.57
$127.55
$27.23
$100.32
$0.00
$63.77
$0.00
$113.93
$35.47
$78.46
$118.59
$35.47
$83.12
$172.33
$46.58
$125.76
$127.55
$35.11
$92.44
Percent
Change in
Payment Rate
-0.1%
-0.2%
-0.6%
-0.0%
-0.1%
0.2%
-0.2%
-0.4%
-0.3%
-0.4%
-0.4%
-0.9%
-0.2%
-0.2%
-0.3%
-0.2%
-1.8%
0.2%
-0.3%
0.3%
0.1%
-0.3%
0.3%
-1.1%
-0.3%
-1.4%
-1.4%
-0.6%
-1.3%
-0.3%
0.3%
0.7%
0.1%
-0.1%
-0.3%
-0.0%
-1.1%
-3.3%
-0.3%
CPT
Code
74247
74247
74247
74249
74249
74249
74250
74250
74250
74251
74251
74251
74260
74260
74260
74261
74261
74261
74262
74262
74262
74263
74263
74263
74270
74270
74270
74280
74280
74280
74283
74283
74283
74290
74290
74290
74300
74300
74300
74301
74301
74301
74328
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Contrst x-ray uppr gi tract
Contrst x-ray uppr gi tract
Contrst x-ray uppr gi tract
Contrst x-ray uppr gi tract
Contrst x-ray uppr gi tract
Contrst x-ray uppr gi tract
X-ray exam of small bowel
X-ray exam of small bowel
X-ray exam of small bowel
X-ray exam of small bowel
X-ray exam of small bowel
X-ray exam of small bowel
X-ray exam of small bowel
X-ray exam of small bowel
X-ray exam of small bowel
Ct colonography dx
Ct colonography dx
Ct colonography dx
Ct colonography dx w/dye
Ct colonography dx w/dye
Ct colonography dx w/dye
Ct colonography screening
Ct colonography screening
Ct colonography screening
Contrast x-ray exam of colon
Contrast x-ray exam of colon
Contrast x-ray exam of colon
Contrast x-ray exam of colon
Contrast x-ray exam of colon
Contrast x-ray exam of colon
Contrast x-ray exam of colon
Contrast x-ray exam of colon
Contrast x-ray exam of colon
Contrast x-ray gallbladder
Contrast x-ray gallbladder
Contrast x-ray gallbladder
X-ray bile ducts/pancreas
X-ray bile ducts/pancreas
X-ray bile ducts/pancreas
X-rays at surgery add-on
X-rays at surgery add-on
X-rays at surgery add-on
X-ray bile duct endoscopy
$141.94
$35.57
$106.36
$184.70
$46.71
$137.98
$104.93
$24.43
$80.49
$186.85
$35.57
$151.28
$127.92
$25.87
$102.05
$243.99
$123.97
$120.02
$369.76
$129.00
$240.75
$760.71
$116.42
$644.29
$150.92
$35.57
$115.35
$201.95
$51.03
$150.92
$209.13
$106.72
$102.41
$70.43
$16.53
$53.90
$0.00
$19.04
$0.00
$0.00
$11.14
$0.00
$0.00
Page 17 of 45
2016
Payment
Rate
$135.79
$35.47
$100.32
$184.87
$46.58
$138.30
$104.26
$24.00
$80.25
$227.15
$35.47
$191.68
$217.12
$25.44
$191.68
$235.39
$122.89
$112.50
$364.01
$127.91
$236.11
$760.27
$115.37
$644.90
$135.79
$35.47
$100.32
$213.89
$50.88
$163.02
$206.73
$104.26
$102.47
$70.58
$16.48
$54.10
$0.00
$18.63
$0.00
$0.00
$10.75
$0.00
$0.00
Percent
Change in
Payment Rate
-4.3%
-0.3%
-5.7%
0.1%
-0.3%
0.2%
-0.6%
-1.8%
-0.3%
21.6%
-0.3%
26.7%
69.7%
-1.7%
87.8%
-3.5%
-0.9%
-6.3%
-1.6%
-0.8%
-1.9%
-0.1%
-0.9%
0.1%
-10.0%
-0.3%
-13.0%
5.9%
-0.3%
8.0%
-1.2%
-2.3%
0.1%
0.2%
-0.3%
0.4%
-2.2%
-3.5%
CPT
Code
74328
74328
74329
74329
74329
74330
74330
74330
74340
74340
74340
74355
74355
74355
74360
74360
74360
74363
74363
74363
74400
74400
74400
74410
74410
74410
74415
74415
74415
74420
74420
74420
74425
74425
74425
74430
74430
74430
74440
74440
74440
74445
74445
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
Description
2015
Payment
Rate
X-ray bile duct endoscopy
X-ray bile duct endoscopy
X-ray for pancreas endoscopy
X-ray for pancreas endoscopy
X-ray for pancreas endoscopy
X-ray bile/panc endoscopy
X-ray bile/panc endoscopy
X-ray bile/panc endoscopy
X-ray guide for gi tube
X-ray guide for gi tube
X-ray guide for gi tube
X-ray guide intestinal tube
X-ray guide intestinal tube
X-ray guide intestinal tube
X-ray guide gi dilation
X-ray guide gi dilation
X-ray guide gi dilation
X-ray bile duct dilation
X-ray bile duct dilation
X-ray bile duct dilation
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrst x-ray urinary tract
Contrast x-ray bladder
Contrast x-ray bladder
Contrast x-ray bladder
X-ray male genital tract
X-ray male genital tract
X-ray male genital tract
X-ray exam of penis
X-ray exam of penis
$37.37
$0.00
$0.00
$37.01
$0.00
$0.00
$47.43
$0.00
$0.00
$28.03
$0.00
$0.00
$40.25
$0.00
$0.00
$29.11
$0.00
$0.00
$45.28
$0.00
$109.96
$24.79
$85.16
$107.08
$24.08
$83.01
$137.27
$24.79
$112.47
$0.00
$18.33
$0.00
$0.00
$18.33
$0.00
$37.37
$16.17
$21.20
$80.13
$18.69
$61.45
$0.00
$59.29
Page 18 of 45
2016
Payment
Rate
$36.19
$0.00
$0.00
$36.54
$0.00
$0.00
$46.22
$0.00
$0.00
$27.59
$0.00
$0.00
$39.41
$0.00
$0.00
$29.02
$0.00
$0.00
$43.71
$0.00
$109.99
$25.08
$84.91
$108.56
$24.72
$83.84
$137.22
$25.08
$112.14
$0.00
$17.91
$0.00
$0.00
$17.91
$0.00
$37.62
$16.12
$21.50
$81.69
$18.63
$63.06
$0.00
$55.18
Percent
Change in
Payment Rate
-3.2%
-1.3%
-2.6%
-1.6%
-2.1%
-0.3%
-3.5%
0.0%
1.2%
-0.3%
1.4%
2.7%
1.0%
-0.0%
1.2%
-0.3%
-2.2%
-2.2%
0.7%
-0.3%
1.4%
1.9%
-0.3%
2.6%
-6.9%
CPT
Code
74445
74450
74450
74450
74455
74455
74455
74470
74470
74470
74485
74485
74485
74710
74710
74710
74712
74712
74712
74713
74713
74713
74740
74740
74740
74742
74742
74742
74775
74775
74775
75557
75557
75557
75559
75559
75559
75561
75561
75561
75563
75563
75563
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
X-ray exam of penis
X-ray urethra/bladder
X-ray urethra/bladder
X-ray urethra/bladder
X-ray urethra/bladder
X-ray urethra/bladder
X-ray urethra/bladder
X-ray exam of kidney lesion
X-ray exam of kidney lesion
X-ray exam of kidney lesion
X-ray guide gu dilation
X-ray guide gu dilation
X-ray guide gu dilation
X-ray measurement of pelvis
X-ray measurement of pelvis
X-ray measurement of pelvis
Mri fetal sngl/1st gestation
Mri fetal sngl/1st gestation
Mri fetal sngl/1st gestation
Mri fetal ea addl gestation
Mri fetal ea addl gestation
Mri fetal ea addl gestation
X-ray female genital tract
X-ray female genital tract
X-ray female genital tract
X-ray fallopian tube
X-ray fallopian tube
X-ray fallopian tube
X-ray exam of perineum
X-ray exam of perineum
X-ray exam of perineum
Cardiac mri for morph
Cardiac mri for morph
Cardiac mri for morph
Cardiac mri w/stress img
Cardiac mri w/stress img
Cardiac mri w/stress img
Cardiac mri for morph w/dye
Cardiac mri for morph w/dye
Cardiac mri for morph w/dye
Card mri w/stress img & dye
Card mri w/stress img & dye
Card mri w/stress img & dye
$0.00
$0.00
$16.89
$0.00
$81.93
$16.53
$65.40
$0.00
$26.95
$0.00
$92.35
$26.23
$66.12
$40.25
$17.97
$22.28
$75.82
$19.76
$56.06
$0.00
$31.98
$0.00
$0.00
$32.34
$0.00
$320.53
$118.94
$201.59
$432.28
$145.89
$286.39
$427.61
$131.52
$296.09
$507.38
$150.92
$356.46
Page 19 of 45
2016
Payment
Rate
$0.00
$0.00
$16.84
$0.00
$82.05
$16.84
$65.21
$0.00
$26.87
$0.00
$92.79
$26.51
$66.28
$36.90
$17.56
$19.35
$426.71
$153.70
$273.01
$232.88
$91.00
$141.88
$75.24
$19.35
$55.89
$0.00
$30.10
$0.00
$0.00
$31.89
$0.00
$319.94
$117.87
$202.07
$437.82
$145.46
$292.36
$424.92
$130.06
$294.86
$504.46
$149.04
$355.41
Percent
Change in
Payment Rate
-0.3%
0.1%
1.9%
-0.3%
-0.3%
0.5%
1.1%
0.2%
-8.3%
-2.3%
-13.2%
-0.8%
-2.1%
-0.3%
-5.9%
-1.4%
-0.2%
-0.9%
0.2%
1.3%
-0.3%
2.1%
-0.6%
-1.1%
-0.4%
-0.6%
-1.2%
-0.3%
CPT
Code
75565
75565
75565
75571
75571
75571
75572
75572
75572
75573
75573
75573
75574
75574
75574
75600
75600
75600
75605
75605
75605
75625
75625
75625
75630
75630
75630
75635
75635
75635
75658
75658
75658
75705
75705
75705
75710
75710
75710
75716
75716
75716
75726
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
2015
Payment
Rate
Description
Card mri veloc flow mapping
Card mri veloc flow mapping
Card mri veloc flow mapping
Ct hrt w/o dye w/ca test
Ct hrt w/o dye w/ca test
Ct hrt w/o dye w/ca test
Ct hrt w/3d image
Ct hrt w/3d image
Ct hrt w/3d image
Ct hrt w/3d image congen
Ct hrt w/3d image congen
Ct hrt w/3d image congen
Ct angio hrt w/3d image
Ct angio hrt w/3d image
Ct angio hrt w/3d image
Contrast exam thoracic aorta
Contrast exam thoracic aorta
Contrast exam thoracic aorta
Contrast exam thoracic aorta
Contrast exam thoracic aorta
Contrast exam thoracic aorta
Contrast exam abdominl aorta
Contrast exam abdominl aorta
Contrast exam abdominl aorta
X-ray aorta leg arteries
X-ray aorta leg arteries
X-ray aorta leg arteries
Ct angio abdominal arteries
Ct angio abdominal arteries
Ct angio abdominal arteries
Artery x-rays arm
Artery x-rays arm
Artery x-rays arm
Artery x-rays spine
Artery x-rays spine
Artery x-rays spine
Artery x-rays arm/leg
Artery x-rays arm/leg
Artery x-rays arm/leg
Artery x-rays arms/legs
Artery x-rays arms/legs
Artery x-rays arms/legs
Artery x-rays abdomen
Page 20 of 45
$55.70
$12.58
$43.12
$58.93
$29.47
$29.47
$286.75
$88.76
$197.99
$343.52
$127.56
$215.96
$336.70
$120.74
$215.96
$201.95
$26.59
$175.36
$140.86
$57.85
$83.01
$140.86
$58.21
$82.65
$174.28
$91.63
$82.65
$382.69
$122.17
$260.52
$168.89
$67.20
$101.69
$238.60
$109.24
$129.36
$162.78
$55.34
$107.44
$188.65
$66.12
$122.53
$152.00
2016
Payment
Rate
$55.18
$12.54
$42.64
$42.28
$29.38
$12.90
$285.19
$88.14
$197.05
$364.37
$128.26
$236.11
$356.49
$120.38
$236.11
$199.20
$24.72
$174.48
$140.45
$56.97
$83.48
$139.73
$56.97
$82.76
$172.69
$89.93
$82.76
$357.92
$121.46
$236.46
$167.67
$64.85
$102.83
$246.50
$116.44
$130.06
$165.17
$57.32
$107.84
$189.17
$65.57
$123.61
$150.84
Percent
Change in
Payment Rate
-0.9%
-0.3%
-1.1%
-28.3%
-0.3%
-56.2%
-0.5%
-0.7%
-0.5%
6.1%
0.5%
9.3%
5.9%
-0.3%
9.3%
-1.4%
-7.0%
-0.5%
-0.3%
-1.5%
0.6%
-0.8%
-2.1%
0.1%
-0.9%
-1.9%
0.1%
-6.5%
-0.6%
-9.2%
-0.7%
-3.5%
1.1%
3.3%
6.6%
0.5%
1.5%
3.6%
0.4%
0.3%
-0.8%
0.9%
-0.8%
CPT
Code
75726
75726
75731
75731
75731
75733
75733
75733
75736
75736
75736
75741
75741
75741
75743
75743
75743
75746
75746
75746
75756
75756
75756
75774
75774
75774
75791
75791
75791
75801
75801
75801
75803
75803
75803
75805
75805
75805
75807
75807
75807
75809
75809
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
Description
2015
Payment
Rate
Artery x-rays abdomen
Artery x-rays abdomen
Artery x-rays adrenal gland
Artery x-rays adrenal gland
Artery x-rays adrenal gland
Artery x-rays adrenals
Artery x-rays adrenals
Artery x-rays adrenals
Artery x-rays pelvis
Artery x-rays pelvis
Artery x-rays pelvis
Artery x-rays lung
Artery x-rays lung
Artery x-rays lung
Artery x-rays lungs
Artery x-rays lungs
Artery x-rays lungs
Artery x-rays lung
Artery x-rays lung
Artery x-rays lung
Artery x-rays chest
Artery x-rays chest
Artery x-rays chest
Artery x-ray each vessel
Artery x-ray each vessel
Artery x-ray each vessel
Av dialysis shunt imaging
Av dialysis shunt imaging
Av dialysis shunt imaging
Lymph vessel x-ray arm/leg
Lymph vessel x-ray arm/leg
Lymph vessel x-ray arm/leg
Lymph vessel x-ray arms/legs
Lymph vessel x-ray arms/legs
Lymph vessel x-ray arms/legs
Lymph vessel x-ray trunk
Lymph vessel x-ray trunk
Lymph vessel x-ray trunk
Lymph vessel x-ray trunk
Lymph vessel x-ray trunk
Lymph vessel x-ray trunk
Nonvascular shunt x-ray
Nonvascular shunt x-ray
$57.85
$94.15
$172.48
$57.85
$114.63
$184.70
$65.04
$119.66
$164.93
$59.65
$105.29
$153.80
$65.40
$88.40
$172.12
$82.65
$89.47
$154.87
$56.77
$98.10
$171.76
$60.01
$111.75
$88.76
$18.33
$70.43
$323.40
$84.08
$239.32
$0.00
$46.35
$0.00
$0.00
$61.81
$0.00
$0.00
$42.40
$0.00
$0.00
$61.81
$0.00
$99.90
$24.08
Page 21 of 45
2016
Payment
Rate
$56.61
$94.23
$174.12
$58.40
$115.72
$185.59
$64.49
$121.10
$161.58
$56.25
$105.33
$152.63
$64.85
$87.78
$170.90
$82.05
$88.85
$153.70
$57.32
$96.38
$168.03
$57.32
$110.71
$88.49
$17.91
$70.58
$327.47
$87.78
$239.69
$0.00
$45.50
$0.00
$0.00
$59.83
$0.00
$0.00
$41.56
$0.00
$0.00
$60.19
$0.00
$100.32
$24.36
Percent
Change in
Payment Rate
-2.2%
0.1%
1.0%
0.9%
1.0%
0.5%
-0.8%
1.2%
-2.0%
-5.7%
0.0%
-0.8%
-0.8%
-0.7%
-0.7%
-0.7%
-0.7%
-0.8%
1.0%
-1.8%
-2.2%
-4.5%
-0.9%
-0.3%
-2.2%
0.2%
1.3%
4.4%
0.2%
-1.8%
-3.2%
-2.0%
-2.6%
0.4%
1.2%
CPT
Code
75809
75810
75810
75810
75820
75820
75820
75822
75822
75822
75825
75825
75825
75827
75827
75827
75831
75831
75831
75833
75833
75833
75840
75840
75840
75842
75842
75842
75860
75860
75860
75870
75870
75870
75872
75872
75872
75880
75880
75880
75885
75885
75885
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
2015
Payment
Rate
Description
Nonvascular shunt x-ray
Vein x-ray spleen/liver
Vein x-ray spleen/liver
Vein x-ray spleen/liver
Vein x-ray arm/leg
Vein x-ray arm/leg
Vein x-ray arm/leg
Vein x-ray arms/legs
Vein x-ray arms/legs
Vein x-ray arms/legs
Vein x-ray trunk
Vein x-ray trunk
Vein x-ray trunk
Vein x-ray chest
Vein x-ray chest
Vein x-ray chest
Vein x-ray kidney
Vein x-ray kidney
Vein x-ray kidney
Vein x-ray kidneys
Vein x-ray kidneys
Vein x-ray kidneys
Vein x-ray adrenal gland
Vein x-ray adrenal gland
Vein x-ray adrenal gland
Vein x-ray adrenal glands
Vein x-ray adrenal glands
Vein x-ray adrenal glands
Vein x-ray neck
Vein x-ray neck
Vein x-ray neck
Vein x-ray skull
Vein x-ray skull
Vein x-ray skull
Vein x-ray skull epidural
Vein x-ray skull epidural
Vein x-ray skull epidural
Vein x-ray eye socket
Vein x-ray eye socket
Vein x-ray eye socket
Vein x-ray liver w/hemodynam
Vein x-ray liver w/hemodynam
Vein x-ray liver w/hemodynam
Page 22 of 45
$75.82
$0.00
$60.37
$0.00
$116.78
$35.93
$80.85
$139.06
$53.54
$85.52
$138.70
$58.21
$80.49
$139.78
$57.13
$82.65
$142.30
$55.70
$86.60
$170.68
$78.69
$91.99
$150.56
$58.93
$91.63
$182.90
$77.26
$105.64
$145.89
$57.85
$88.04
$150.20
$58.93
$91.27
$150.92
$58.93
$91.99
$147.33
$36.65
$110.68
$159.90
$71.15
$88.76
2016
Payment
Rate
$75.96
$0.00
$58.40
$0.00
$116.80
$35.47
$81.33
$139.01
$53.38
$85.63
$138.30
$57.68
$80.61
$140.09
$57.32
$82.76
$141.88
$56.25
$85.63
$166.24
$73.81
$92.44
$150.12
$58.40
$91.72
$182.36
$75.96
$106.41
$144.74
$56.97
$87.78
$149.40
$58.40
$91.00
$141.88
$54.46
$87.42
$144.39
$36.90
$107.48
$159.79
$70.58
$89.21
Percent
Change in
Payment Rate
0.2%
-3.3%
0.0%
-1.3%
0.6%
-0.0%
-0.3%
0.1%
-0.3%
-0.9%
0.2%
0.2%
0.3%
0.1%
-0.3%
1.0%
-1.1%
-2.6%
-6.2%
0.5%
-0.3%
-0.9%
0.1%
-0.3%
-1.7%
0.7%
-0.8%
-1.5%
-0.3%
-0.5%
-0.9%
-0.3%
-6.0%
-7.6%
-5.0%
-2.0%
0.7%
-2.9%
-0.1%
-0.8%
0.5%
CPT
Code
75887
75887
75887
75889
75889
75889
75891
75891
75891
75893
75893
75893
75894
75894
75894
75898
75898
75898
75901
75901
75901
75902
75902
75902
75952
75952
75952
75953
75953
75953
75954
75954
75954
75956
75956
75956
75957
75957
75957
75958
75958
75958
75959
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
2015
Payment
Rate
Description
Vein x-ray liver w/o hemodyn
Vein x-ray liver w/o hemodyn
Vein x-ray liver w/o hemodyn
Vein x-ray liver w/hemodynam
Vein x-ray liver w/hemodynam
Vein x-ray liver w/hemodynam
Vein x-ray liver
Vein x-ray liver
Vein x-ray liver
Venous sampling by catheter
Venous sampling by catheter
Venous sampling by catheter
X-rays transcath therapy
X-rays transcath therapy
X-rays transcath therapy
Follow-up angiography
Follow-up angiography
Follow-up angiography
Remove cva device obstruct
Remove cva device obstruct
Remove cva device obstruct
Remove cva lumen obstruct
Remove cva lumen obstruct
Remove cva lumen obstruct
Endovasc repair abdom aorta
Endovasc repair abdom aorta
Endovasc repair abdom aorta
Abdom aneurysm endovas rpr
Abdom aneurysm endovas rpr
Abdom aneurysm endovas rpr
Iliac aneurysm endovas rpr
Iliac aneurysm endovas rpr
Iliac aneurysm endovas rpr
Xray endovasc thor ao repr
Xray endovasc thor ao repr
Xray endovasc thor ao repr
Xray endovasc thor ao repr
Xray endovasc thor ao repr
Xray endovasc thor ao repr
Xray place prox ext thor ao
Xray place prox ext thor ao
Xray place prox ext thor ao
Xray place dist ext thor ao
Page 23 of 45
$162.06
$72.23
$89.83
$145.89
$56.42
$89.47
$147.69
$57.49
$90.19
$120.02
$27.67
$92.35
$0.00
$68.27
$0.00
$0.00
$87.68
$0.00
$176.43
$23.72
$152.72
$72.23
$19.40
$52.82
$0.00
$235.72
$0.00
$0.00
$71.51
$0.00
$0.00
$119.30
$0.00
$0.00
$367.24
$0.00
$0.00
$314.78
$0.00
$0.00
$209.49
$0.00
$0.00
2016
Payment
Rate
$160.51
$70.94
$89.57
$145.46
$56.25
$89.21
$146.89
$56.97
$89.93
$119.31
$27.59
$91.72
$0.00
$67.71
$0.00
$0.00
$85.63
$0.00
$178.42
$24.36
$154.06
$72.37
$19.35
$53.03
$0.00
$229.66
$0.00
$0.00
$69.51
$0.00
$0.00
$116.08
$0.00
$0.00
$358.64
$0.00
$0.00
$307.76
$0.00
$0.00
$204.22
$0.00
$0.00
Percent
Change in
Payment Rate
-1.0%
-1.8%
-0.3%
-0.3%
-0.3%
-0.3%
-0.5%
-0.9%
-0.3%
-0.6%
-0.3%
-0.7%
-0.8%
-2.3%
1.1%
2.7%
0.9%
0.2%
-0.3%
0.4%
-2.6%
-2.8%
-2.7%
-2.3%
-2.2%
-2.5%
CPT
Code
75959
75959
75962
75962
75962
75964
75964
75964
75966
75966
75966
75968
75968
75968
75970
75970
75970
75978
75978
75978
75984
75984
75984
75989
75989
75989
76000
76000
76000
76001
76001
76001
76010
76010
76010
76080
76080
76080
76098
76098
76098
76100
76100
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
Description
2015
Payment
Rate
Xray place dist ext thor ao
Xray place dist ext thor ao
Repair arterial blockage
Repair arterial blockage
Repair arterial blockage
Repair artery blockage each
Repair artery blockage each
Repair artery blockage each
Repair arterial blockage
Repair arterial blockage
Repair arterial blockage
Repair artery blockage each
Repair artery blockage each
Repair artery blockage each
Vascular biopsy
Vascular biopsy
Vascular biopsy
Repair venous blockage
Repair venous blockage
Repair venous blockage
Xray control catheter change
Xray control catheter change
Xray control catheter change
Abscess drainage under x-ray
Abscess drainage under x-ray
Abscess drainage under x-ray
Fluoroscope examination
Fluoroscope examination
Fluoroscope examination
Fluoroscope exam extensive
Fluoroscope exam extensive
Fluoroscope exam extensive
X-ray nose to rectum
X-ray nose to rectum
X-ray nose to rectum
X-ray exam of fistula
X-ray exam of fistula
X-ray exam of fistula
X-ray exam breast specimen
X-ray exam breast specimen
X-ray exam breast specimen
X-ray exam of body section
X-ray exam of body section
$180.39
$0.00
$139.78
$26.23
$113.55
$86.96
$17.61
$69.35
$173.20
$65.40
$107.80
$89.47
$17.97
$71.51
$0.00
$41.68
$0.00
$138.34
$26.23
$112.11
$107.44
$35.93
$71.51
$122.53
$60.37
$62.17
$47.43
$8.98
$38.45
$0.00
$37.37
$0.00
$26.23
$9.34
$16.89
$55.70
$26.95
$28.75
$16.53
$8.26
$8.26
$93.43
$32.70
Page 24 of 45
2016
Payment
Rate
$178.06
$0.00
$141.52
$27.23
$114.29
$89.21
$18.27
$70.94
$173.05
$65.57
$107.48
$88.49
$18.27
$70.22
$0.00
$40.84
$0.00
$139.73
$27.23
$112.50
$107.48
$35.83
$71.66
$121.81
$59.47
$62.34
$47.65
$8.96
$38.69
$0.00
$36.90
$0.00
$26.15
$9.32
$16.84
$55.53
$26.87
$28.66
$16.84
$8.24
$8.60
$93.51
$32.60
Percent
Change in
Payment Rate
-1.3%
1.2%
3.8%
0.7%
2.6%
3.8%
2.3%
-0.1%
0.3%
-0.3%
-1.1%
1.7%
-1.8%
-2.0%
1.0%
3.8%
0.3%
0.0%
-0.3%
0.2%
-0.6%
-1.5%
0.3%
0.5%
-0.3%
0.6%
-1.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
1.9%
-0.3%
4.0%
0.1%
-0.3%
CPT
Code
76100
76101
76101
76101
76102
76102
76102
76120
76120
76120
76125
76125
76125
76140
76376
76376
76376
76377
76377
76377
76380
76380
76380
76390
76390
76390
76496
76496
76496
76497
76497
76497
76498
76498
76498
76499
76499
76499
76506
76506
76506
76510
76510
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
Description
2015
Payment
Rate
X-ray exam of body section
Complex body section x-ray
Complex body section x-ray
Complex body section x-ray
Complex body section x-rays
Complex body section x-rays
Complex body section x-rays
Cine/video x-rays
Cine/video x-rays
Cine/video x-rays
Cine/video x-rays add-on
Cine/video x-rays add-on
Cine/video x-rays add-on
X-ray consultation
3d render w/intrp postproces
3d render w/intrp postproces
3d render w/intrp postproces
3d render w/intrp postproces
3d render w/intrp postproces
3d render w/intrp postproces
Cat scan follow-up study
Cat scan follow-up study
Cat scan follow-up study
Mr spectroscopy
Mr spectroscopy
Mr spectroscopy
Fluoroscopic procedure
Fluoroscopic procedure
Fluoroscopic procedure
Ct procedure
Ct procedure
Ct procedure
Mri procedure
Mri procedure
Mri procedure
Radiographic procedure
Radiographic procedure
Radiographic procedure
Echo exam of head
Echo exam of head
Echo exam of head
Ophth us b & quant a
Ophth us b & quant a
$60.73
$133.67
$35.93
$97.74
$175.71
$35.93
$139.78
$91.63
$20.48
$71.15
$0.00
$15.09
$0.00
$0.00
$23.00
$10.06
$12.94
$64.68
$40.25
$24.43
$109.60
$49.95
$59.65
$448.81
$71.51
$377.30
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$120.38
$32.70
$87.68
$172.48
$90.19
Page 25 of 45
2016
Payment
Rate
$60.91
$132.92
$34.39
$98.53
$176.63
$35.11
$141.52
$84.20
$19.71
$64.49
$0.00
$14.69
$0.00
$0.00
$23.29
$10.03
$13.26
$65.21
$40.49
$24.72
$111.07
$50.16
$60.91
$448.21
$70.94
$377.27
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$119.67
$32.96
$86.70
$172.69
$90.29
Percent
Change in
Payment Rate
0.3%
-0.6%
-4.3%
0.8%
0.5%
-2.3%
1.2%
-8.1%
-3.8%
-9.4%
-2.7%
1.3%
-0.3%
2.5%
0.8%
0.6%
1.2%
1.3%
0.4%
2.1%
-0.1%
-0.8%
-0.0%
-0.6%
0.8%
-1.1%
0.1%
0.1%
CPT
Code
76510
76511
76511
76511
76512
76512
76512
76513
76513
76513
76514
76514
76514
76516
76516
76516
76519
76519
76519
76529
76529
76529
76536
76536
76536
76604
76604
76604
76641
76641
76641
76642
76642
76642
76700
76700
76700
76705
76705
76705
76770
76770
76770
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Ophth us b & quant a
Ophth us quant a only
Ophth us quant a only
Ophth us quant a only
Ophth us b w/non-quant a
Ophth us b w/non-quant a
Ophth us b w/non-quant a
Echo exam of eye water bath
Echo exam of eye water bath
Echo exam of eye water bath
Echo exam of eye thickness
Echo exam of eye thickness
Echo exam of eye thickness
Echo exam of eye
Echo exam of eye
Echo exam of eye
Echo exam of eye
Echo exam of eye
Echo exam of eye
Echo exam of eye
Echo exam of eye
Echo exam of eye
Us exam of head and neck
Us exam of head and neck
Us exam of head and neck
Us exam chest
Us exam chest
Us exam chest
Ultrasound breast complete
Ultrasound breast complete
Ultrasound breast complete
Ultrasound breast limited
Ultrasound breast limited
Ultrasound breast limited
Us exam abdom complete
Us exam abdom complete
Us exam abdom complete
Echo exam of abdomen
Echo exam of abdomen
Echo exam of abdomen
Us exam abdo back wall comp
Us exam abdo back wall comp
Us exam abdo back wall comp
$82.29
$104.21
$54.26
$49.95
$94.15
$53.90
$40.25
$97.38
$36.65
$60.73
$15.45
$10.06
$5.39
$79.77
$31.62
$48.15
$85.52
$31.62
$53.90
$80.85
$33.06
$47.79
$117.86
$28.39
$89.47
$89.47
$28.03
$61.45
$109.96
$37.73
$72.23
$90.55
$35.21
$55.34
$124.69
$41.32
$83.37
$93.07
$30.18
$62.88
$114.63
$37.37
$77.26
Page 26 of 45
2016
Payment
Rate
$82.40
$102.47
$53.74
$48.73
$93.87
$53.74
$40.13
$96.02
$36.19
$59.83
$15.41
$10.03
$5.37
$79.90
$31.53
$48.37
$85.63
$31.89
$53.74
$80.25
$32.96
$47.29
$117.52
$28.66
$88.85
$89.21
$27.59
$61.62
$108.92
$37.26
$71.66
$89.57
$34.75
$54.82
$124.32
$41.20
$83.12
$92.44
$30.10
$62.34
$114.65
$37.62
$77.03
Percent
Change in
Payment Rate
0.1%
-1.7%
-1.0%
-2.4%
-0.3%
-0.3%
-0.3%
-1.4%
-1.3%
-1.5%
-0.3%
-0.3%
-0.3%
0.2%
-0.3%
0.5%
0.1%
0.8%
-0.3%
-0.7%
-0.3%
-1.0%
-0.3%
1.0%
-0.7%
-0.3%
-1.6%
0.3%
-0.9%
-1.2%
-0.8%
-1.1%
-1.3%
-0.9%
-0.3%
-0.3%
-0.3%
-0.7%
-0.3%
-0.9%
0.0%
0.7%
-0.3%
CPT
Code
76775
76775
76775
76776
76776
76776
76800
76800
76800
76801
76801
76801
76802
76802
76802
76805
76805
76805
76810
76810
76810
76811
76811
76811
76812
76812
76812
76813
76813
76813
76814
76814
76814
76815
76815
76815
76816
76816
76816
76817
76817
76817
76818
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Us exam abdo back wall lim
Us exam abdo back wall lim
Us exam abdo back wall lim
Us exam k transpl w/doppler
Us exam k transpl w/doppler
Us exam k transpl w/doppler
Us exam spinal canal
Us exam spinal canal
Us exam spinal canal
Ob us < 14 wks single fetus
Ob us < 14 wks single fetus
Ob us < 14 wks single fetus
Ob us < 14 wks addl fetus
Ob us < 14 wks addl fetus
Ob us < 14 wks addl fetus
Ob us >/= 14 wks sngl fetus
Ob us >/= 14 wks sngl fetus
Ob us >/= 14 wks sngl fetus
Ob us >/= 14 wks addl fetus
Ob us >/= 14 wks addl fetus
Ob us >/= 14 wks addl fetus
Ob us detailed sngl fetus
Ob us detailed sngl fetus
Ob us detailed sngl fetus
Ob us detailed addl fetus
Ob us detailed addl fetus
Ob us detailed addl fetus
Ob us nuchal meas 1 gest
Ob us nuchal meas 1 gest
Ob us nuchal meas 1 gest
Ob us nuchal meas add-on
Ob us nuchal meas add-on
Ob us nuchal meas add-on
Ob us limited fetus(s)
Ob us limited fetus(s)
Ob us limited fetus(s)
Ob us follow-up per fetus
Ob us follow-up per fetus
Ob us follow-up per fetus
Transvaginal us obstetric
Transvaginal us obstetric
Transvaginal us obstetric
Fetal biophys profile w/nst
$58.21
$29.11
$29.11
$158.83
$38.81
$120.02
$139.78
$57.85
$81.93
$126.49
$52.46
$74.02
$66.84
$43.84
$23.00
$145.17
$52.46
$92.71
$96.66
$52.10
$44.56
$185.42
$100.97
$84.44
$210.21
$95.22
$114.99
$123.97
$62.88
$61.09
$83.37
$52.82
$30.54
$86.24
$34.14
$52.10
$117.14
$44.92
$72.23
$99.18
$39.53
$59.65
$123.97
Page 27 of 45
2016
Payment
Rate
$58.76
$29.38
$29.38
$158.72
$38.69
$120.02
$143.67
$61.62
$82.05
$125.40
$51.23
$74.16
$65.92
$43.35
$22.57
$144.03
$51.59
$92.44
$95.30
$51.23
$44.07
$185.59
$100.32
$85.27
$210.31
$94.23
$116.08
$123.61
$62.34
$61.27
$83.12
$52.67
$30.45
$85.63
$33.32
$52.31
$117.16
$44.78
$72.37
$98.89
$39.05
$59.83
$123.96
Percent
Change in
Payment Rate
0.9%
0.9%
0.9%
-0.1%
-0.3%
0.0%
2.8%
6.5%
0.1%
-0.9%
-2.3%
0.2%
-1.4%
-1.1%
-1.9%
-0.8%
-1.7%
-0.3%
-1.4%
-1.7%
-1.1%
0.1%
-0.6%
1.0%
0.0%
-1.0%
1.0%
-0.3%
-0.9%
0.3%
-0.3%
-0.3%
-0.3%
-0.7%
-2.4%
0.4%
0.0%
-0.3%
0.2%
-0.3%
-1.2%
0.3%
-0.0%
CPT
Code
76818
76818
76819
76819
76819
76820
76820
76820
76821
76821
76821
76825
76825
76825
76826
76826
76826
76827
76827
76827
76828
76828
76828
76830
76830
76830
76831
76831
76831
76856
76856
76856
76857
76857
76857
76870
76870
76870
76872
76872
76872
76873
76873
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
Description
2015
Payment
Rate
Fetal biophys profile w/nst
Fetal biophys profile w/nst
Fetal biophys profil w/o nst
Fetal biophys profil w/o nst
Fetal biophys profil w/o nst
Umbilical artery echo
Umbilical artery echo
Umbilical artery echo
Middle cerebral artery echo
Middle cerebral artery echo
Middle cerebral artery echo
Echo exam of fetal heart
Echo exam of fetal heart
Echo exam of fetal heart
Echo exam of fetal heart
Echo exam of fetal heart
Echo exam of fetal heart
Echo exam of fetal heart
Echo exam of fetal heart
Echo exam of fetal heart
Echo exam of fetal heart
Echo exam of fetal heart
Echo exam of fetal heart
Transvaginal us non-ob
Transvaginal us non-ob
Transvaginal us non-ob
Echo exam uterus
Echo exam uterus
Echo exam uterus
Us exam pelvic complete
Us exam pelvic complete
Us exam pelvic complete
Us exam pelvic limited
Us exam pelvic limited
Us exam pelvic limited
Us exam scrotum
Us exam scrotum
Us exam scrotum
Us transrectal
Us transrectal
Us transrectal
Echograp trans r pros study
Echograp trans r pros study
$56.06
$67.91
$90.55
$40.60
$49.95
$48.15
$26.23
$21.92
$94.51
$37.01
$57.49
$282.08
$87.32
$194.76
$167.09
$43.12
$123.97
$77.62
$29.82
$47.79
$54.62
$29.11
$25.51
$124.33
$35.93
$88.40
$120.74
$38.09
$82.65
$111.39
$34.86
$76.54
$47.79
$24.79
$23.00
$67.56
$31.98
$35.57
$94.86
$34.14
$60.73
$168.53
$78.69
Page 28 of 45
2016
Payment
Rate
$55.53
$68.43
$90.64
$40.49
$50.16
$48.73
$26.51
$22.21
$94.59
$36.90
$57.68
$280.89
$85.63
$195.26
$165.88
$42.28
$123.61
$77.03
$29.38
$47.65
$54.46
$29.02
$25.44
$123.61
$35.47
$88.14
$120.74
$37.62
$83.12
$111.42
$35.11
$76.31
$48.01
$25.08
$22.93
$68.43
$32.60
$35.83
$95.30
$34.04
$61.27
$169.82
$79.18
Percent
Change in
Payment Rate
-0.9%
0.8%
0.1%
-0.3%
0.4%
1.2%
1.1%
1.3%
0.1%
-0.3%
0.3%
-0.4%
-1.9%
0.3%
-0.7%
-2.0%
-0.3%
-0.8%
-1.5%
-0.3%
-0.3%
-0.3%
-0.3%
-0.6%
-1.3%
-0.3%
0.0%
-1.2%
0.6%
0.0%
0.7%
-0.3%
0.5%
1.2%
-0.3%
1.3%
1.9%
0.7%
0.5%
-0.3%
0.9%
0.8%
0.6%
CPT
Code
76873
76881
76881
76881
76882
76882
76882
76885
76885
76885
76886
76886
76886
76930
76930
76930
76932
76932
76932
76936
76936
76936
76937
76937
76937
76940
76940
76940
76941
76941
76941
76942
76942
76942
76945
76945
76945
76946
76946
76946
76948
76948
76948
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Echograp trans r pros study
Us xtr non-vasc complete
Us xtr non-vasc complete
Us xtr non-vasc complete
Us xtr non-vasc lmtd
Us xtr non-vasc lmtd
Us xtr non-vasc lmtd
Us exam infant hips dynamic
Us exam infant hips dynamic
Us exam infant hips dynamic
Us exam infant hips static
Us exam infant hips static
Us exam infant hips static
Echo guide cardiocentesis
Echo guide cardiocentesis
Echo guide cardiocentesis
Echo guide for heart biopsy
Echo guide for heart biopsy
Echo guide for heart biopsy
Echo guide for artery repair
Echo guide for artery repair
Echo guide for artery repair
Us guide vascular access
Us guide vascular access
Us guide vascular access
Us guide tissue ablation
Us guide tissue ablation
Us guide tissue ablation
Echo guide for transfusion
Echo guide for transfusion
Echo guide for transfusion
Echo guide for biopsy
Echo guide for biopsy
Echo guide for biopsy
Echo guide villus sampling
Echo guide villus sampling
Echo guide villus sampling
Echo guide for amniocentesis
Echo guide for amniocentesis
Echo guide for amniocentesis
Echo guide ova aspiration
Echo guide ova aspiration
Echo guide ova aspiration
$89.83
$118.22
$32.34
$85.88
$36.65
$25.15
$11.50
$128.64
$37.01
$91.63
$108.16
$31.98
$76.18
$0.00
$34.14
$0.00
$0.00
$33.78
$0.00
$278.13
$103.13
$175.00
$32.70
$15.09
$17.61
$0.00
$108.16
$0.00
$0.00
$70.43
$0.00
$61.09
$33.78
$27.31
$0.00
$35.93
$0.00
$33.42
$20.12
$13.30
$33.42
$20.12
$13.30
Page 29 of 45
2016
Payment
Rate
$90.64
$116.80
$32.25
$84.55
$36.54
$25.08
$11.46
$129.70
$37.98
$91.72
$107.48
$31.17
$76.31
$0.00
$33.32
$0.00
$0.00
$32.96
$0.00
$275.16
$100.32
$174.84
$31.89
$14.69
$17.20
$0.00
$105.33
$0.00
$0.00
$69.86
$0.00
$61.98
$34.04
$27.95
$0.00
$35.47
$0.00
$33.32
$20.06
$13.26
$75.24
$35.11
$40.13
Percent
Change in
Payment Rate
0.9%
-1.2%
-0.3%
-1.5%
-0.3%
-0.3%
-0.3%
0.8%
2.6%
0.1%
-0.6%
-2.5%
0.2%
-2.4%
-2.4%
-1.1%
-2.7%
-0.1%
-2.5%
-2.7%
-2.3%
-2.6%
-0.8%
1.5%
0.8%
2.3%
-1.3%
-0.3%
-0.3%
-0.3%
125.1%
74.5%
201.8%
CPT
Code
76965
76965
76965
76970
76970
76970
76975
76975
76975
76977
76977
76977
76998
76998
76998
76999
76999
76999
77001
77001
77001
77002
77002
77002
77003
77003
77003
77011
77011
77011
77012
77012
77012
77013
77013
77013
77014
77014
77014
77021
77021
77021
77022
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Echo guidance radiotherapy
Echo guidance radiotherapy
Echo guidance radiotherapy
Ultrasound exam follow-up
Ultrasound exam follow-up
Ultrasound exam follow-up
Gi endoscopic ultrasound
Gi endoscopic ultrasound
Gi endoscopic ultrasound
Us bone density measure
Us bone density measure
Us bone density measure
Us guide intraop
Us guide intraop
Us guide intraop
Echo examination procedure
Echo examination procedure
Echo examination procedure
Fluoroguide for vein device
Fluoroguide for vein device
Fluoroguide for vein device
Needle localization by xray
Needle localization by xray
Needle localization by xray
Fluoroguide for spine inject
Fluoroguide for spine inject
Fluoroguide for spine inject
Ct scan for localization
Ct scan for localization
Ct scan for localization
Ct scan for needle biopsy
Ct scan for needle biopsy
Ct scan for needle biopsy
Ct guide for tissue ablation
Ct guide for tissue ablation
Ct guide for tissue ablation
Ct scan for therapy guide
Ct scan for therapy guide
Ct scan for therapy guide
Mr guidance for needle place
Mr guidance for needle place
Mr guidance for needle place
Mri for tissue ablation
$91.27
$67.56
$23.72
$94.51
$20.84
$73.66
$0.00
$44.92
$0.00
$7.19
$2.87
$4.31
$0.00
$66.48
$0.00
$0.00
$0.00
$0.00
$70.79
$19.04
$51.74
$93.07
$28.39
$64.68
$86.24
$30.90
$55.34
$221.71
$62.88
$158.83
$125.77
$58.57
$67.20
$0.00
$205.54
$0.00
$117.86
$44.20
$73.66
$415.03
$77.26
$337.77
$0.00
Page 30 of 45
2016
Payment
Rate
$91.36
$67.36
$24.00
$94.59
$19.71
$74.88
$0.00
$43.35
$0.00
$7.17
$2.87
$4.30
$0.00
$64.85
$0.00
$0.00
$0.00
$0.00
$70.94
$19.35
$51.59
$93.87
$28.66
$65.21
$87.06
$30.81
$56.25
$224.64
$63.77
$160.87
$125.40
$58.40
$67.00
$0.00
$199.20
$0.00
$118.95
$44.43
$74.52
$405.57
$76.31
$329.26
$0.00
Percent
Change in
Payment Rate
0.1%
-0.3%
1.2%
0.1%
-5.5%
1.7%
-3.5%
-0.3%
-0.3%
-0.3%
-2.4%
0.2%
1.6%
-0.3%
0.9%
1.0%
0.8%
1.0%
-0.3%
1.6%
1.3%
1.4%
1.3%
-0.3%
-0.3%
-0.3%
-3.1%
0.9%
0.5%
1.2%
-2.3%
-1.2%
-2.5%
CPT
Code
77022
77022
77051
77051
77051
77052
77052
77052
77053
77053
77053
77054
77054
77054
77055
77055
77055
77056
77056
77056
77057
77057
77057
77058
77058
77058
77059
77059
77059
77061
77061
77061
77062
77062
77062
77063
77063
77063
77071
77072
77072
77072
77073
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
2015
Payment
Rate
Description
Mri for tissue ablation
Mri for tissue ablation
Computer dx mammogram add-on
Computer dx mammogram add-on
Computer dx mammogram add-on
Comp screen mammogram add-on
Comp screen mammogram add-on
Comp screen mammogram add-on
X-ray of mammary duct
X-ray of mammary duct
X-ray of mammary duct
X-ray of mammary ducts
X-ray of mammary ducts
X-ray of mammary ducts
Mammogram one breast
Mammogram one breast
Mammogram one breast
Mammogram both breasts
Mammogram both breasts
Mammogram both breasts
Mammogram screening
Mammogram screening
Mammogram screening
Mri one breast
Mri one breast
Mri one breast
Mri both breasts
Mri both breasts
Mri both breasts
Breast tomosynthesis uni
Breast tomosynthesis uni
Breast tomosynthesis uni
Breast tomosynthesis bi
Breast tomosynthesis bi
Breast tomosynthesis bi
Breast tomosynthesis bi
Breast tomosynthesis bi
Breast tomosynthesis bi
X-ray stress view
X-rays for bone age
X-rays for bone age
X-rays for bone age
X-rays bone length studies
Page 31 of 45
$223.87
$0.00
$8.98
$3.23
$5.75
$8.98
$3.23
$5.75
$58.57
$18.33
$40.25
$76.90
$23.36
$53.54
$90.55
$35.93
$54.62
$116.42
$44.56
$71.87
$83.01
$35.93
$47.07
$545.47
$83.73
$461.75
$539.72
$83.73
$456.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$56.42
$30.54
$25.87
$48.87
$23.36
$9.70
$13.65
$36.65
2016
Payment
Rate
$216.40
$0.00
$8.24
$2.87
$5.37
$8.24
$2.87
$5.37
$58.76
$18.27
$40.49
$77.39
$23.29
$54.10
$90.64
$35.83
$54.82
$116.44
$44.43
$72.01
$83.12
$35.83
$47.29
$536.34
$83.12
$453.22
$536.34
$83.12
$453.22
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$56.25
$30.45
$25.80
$49.08
$23.29
$9.67
$13.61
$36.54
Percent
Change in
Payment Rate
-3.3%
-8.3%
-11.4%
-6.5%
-8.3%
-11.4%
-6.5%
0.3%
-0.3%
0.6%
0.6%
-0.3%
1.0%
0.1%
-0.3%
0.4%
0.0%
-0.3%
0.2%
0.1%
-0.3%
0.5%
-1.7%
-0.7%
-1.8%
-0.6%
-0.7%
-0.6%
-0.3%
-0.3%
-0.3%
0.4%
-0.3%
-0.3%
-0.3%
-0.3%
CPT
Code
77073
77073
77074
77074
77074
77075
77075
77075
77076
77076
77076
77077
77077
77077
77078
77078
77078
77080
77080
77080
77081
77081
77081
77084
77084
77084
77085
77085
77085
77086
77086
77086
77261
77262
77263
77280
77280
77280
77285
77285
77285
77290
77290
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
Description
2015
Payment
Rate
X-rays bone length studies
X-rays bone length studies
X-rays bone survey limited
X-rays bone survey limited
X-rays bone survey limited
X-rays bone survey complete
X-rays bone survey complete
X-rays bone survey complete
X-rays bone survey infant
X-rays bone survey infant
X-rays bone survey infant
Joint survey single view
Joint survey single view
Joint survey single view
Ct bone density axial
Ct bone density axial
Ct bone density axial
Dxa bone density axial
Dxa bone density axial
Dxa bone density axial
Dxa bone density/peripheral
Dxa bone density/peripheral
Dxa bone density/peripheral
Magnetic image bone marrow
Magnetic image bone marrow
Magnetic image bone marrow
Dxa bone density study
Dxa bone density study
Dxa bone density study
Fracture assessment via dxa
Fracture assessment via dxa
Fracture assessment via dxa
Radiation therapy planning
Radiation therapy planning
Radiation therapy planning
Set radiation therapy field
Set radiation therapy field
Set radiation therapy field
Set radiation therapy field
Set radiation therapy field
Set radiation therapy field
Set radiation therapy field
Set radiation therapy field
$15.09
$21.56
$64.32
$23.00
$41.32
$87.68
$27.67
$60.01
$95.94
$35.93
$60.01
$38.09
$17.25
$20.84
$72.23
$12.58
$59.65
$41.68
$10.42
$31.26
$28.39
$11.14
$17.25
$369.40
$83.01
$286.39
$56.77
$15.45
$41.32
$35.93
$8.98
$26.95
$76.54
$113.91
$166.73
$272.74
$36.29
$236.44
$429.76
$54.62
$375.15
$513.49
$80.85
Page 32 of 45
2016
Payment
Rate
$14.69
$21.86
$64.85
$23.29
$41.56
$88.14
$27.59
$60.55
$96.74
$35.83
$60.91
$37.62
$16.48
$21.14
$73.45
$12.54
$60.91
$41.56
$10.39
$31.17
$28.30
$11.11
$17.20
$355.05
$82.05
$273.01
$56.25
$15.41
$40.84
$35.83
$8.96
$26.87
$76.67
$114.65
$167.67
$276.23
$36.54
$239.69
$435.67
$55.18
$380.49
$520.22
$81.69
Percent
Change in
Payment Rate
-2.7%
1.4%
0.8%
1.3%
0.6%
0.5%
-0.3%
0.9%
0.8%
-0.3%
1.5%
-1.2%
-4.4%
1.4%
1.7%
-0.3%
2.1%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-3.9%
-1.2%
-4.7%
-0.9%
-0.3%
-1.2%
-0.3%
-0.3%
-0.3%
0.2%
0.6%
0.6%
1.3%
0.7%
1.4%
1.4%
1.0%
1.4%
1.3%
1.0%
CPT
Code
77290
77293
77293
77293
77295
77295
77295
77299
77299
77299
77300
77300
77300
77301
77301
77301
77306
77306
77306
77307
77307
77307
77316
77316
77316
77317
77317
77317
77318
77318
77318
77321
77321
77321
77331
77331
77331
77332
77332
77332
77333
77333
77333
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
2015
Payment
Rate
Description
Set radiation therapy field
Respirator motion mgmt simul
Respirator motion mgmt simul
Respirator motion mgmt simul
3-d radiotherapy plan
3-d radiotherapy plan
3-d radiotherapy plan
Radiation therapy planning
Radiation therapy planning
Radiation therapy planning
Radiation therapy dose plan
Radiation therapy dose plan
Radiation therapy dose plan
Radiotherapy dose plan imrt
Radiotherapy dose plan imrt
Radiotherapy dose plan imrt
Telethx isodose plan simple
Telethx isodose plan simple
Telethx isodose plan simple
Telethx isodose plan cplx
Telethx isodose plan cplx
Telethx isodose plan cplx
Brachytx isodose plan simple
Brachytx isodose plan simple
Brachytx isodose plan simple
Brachytx isodose intermed
Brachytx isodose intermed
Brachytx isodose intermed
Brachytx isodose complex
Brachytx isodose complex
Brachytx isodose complex
Special teletx port plan
Special teletx port plan
Special teletx port plan
Special radiation dosimetry
Special radiation dosimetry
Special radiation dosimetry
Radiation treatment aid(s)
Radiation treatment aid(s)
Radiation treatment aid(s)
Radiation treatment aid(s)
Radiation treatment aid(s)
Radiation treatment aid(s)
$432.64
$466.78
$104.21
$362.57
$491.57
$223.51
$268.06
$0.00
$0.00
$0.00
$63.60
$32.34
$31.26
$1,950.83
$415.75
$1,535.08
$146.25
$72.59
$73.66
$286.39
$151.28
$135.11
$187.57
$72.59
$114.99
$245.43
$95.58
$149.84
$354.66
$151.28
$203.38
$92.71
$49.23
$43.48
$64.32
$45.28
$19.04
$83.01
$28.39
$54.62
$53.18
$43.84
$9.34
Page 33 of 45
2016
Payment
Rate
$438.53
$470.78
$104.62
$366.16
$495.50
$224.28
$271.22
$0.00
$0.00
$0.00
$67.36
$32.60
$34.75
$1,973.76
$417.40
$1,556.36
$150.84
$73.09
$77.75
$291.64
$151.55
$140.09
$190.60
$73.45
$117.16
$247.93
$95.66
$152.27
$358.28
$151.55
$206.73
$93.87
$49.80
$44.07
$64.49
$45.50
$18.99
$84.20
$28.66
$55.53
$53.74
$44.07
$9.67
Percent
Change in
Payment Rate
1.4%
0.9%
0.4%
1.0%
0.8%
0.3%
1.2%
5.9%
0.8%
11.2%
1.2%
0.4%
1.4%
3.1%
0.7%
5.5%
1.8%
0.2%
3.7%
1.6%
1.2%
1.9%
1.0%
0.1%
1.6%
1.0%
0.2%
1.6%
1.3%
1.2%
1.4%
0.3%
0.5%
-0.3%
1.4%
1.0%
1.7%
1.1%
0.5%
3.5%
CPT
Code
77334
77334
77334
77336
77338
77338
77338
77370
77371
77372
77373
77385
77386
77387
77399
77399
77399
77401
77402
77407
77412
77417
77422
77423
77424
77425
77427
77431
77432
77435
77469
77470
77470
77470
77499
77499
77499
77520
77522
77523
77525
77600
77600
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
2015
Payment
Rate
Description
Radiation treatment aid(s)
Radiation treatment aid(s)
Radiation treatment aid(s)
Radiation physics consult
Design mlc device for imrt
Design mlc device for imrt
Design mlc device for imrt
Radiation physics consult
Srs multisource
Srs linear based
Sbrt delivery
Ntsty modul rad tx dlvr smpl
Ntsty modul rad tx dlvr cplx
Guidance for radiaj tx dlvr
External radiation dosimetry
External radiation dosimetry
External radiation dosimetry
Radiation treatment delivery
Radiation treatment delivery
Radiation treatment delivery
Radiation treatment delivery
Radiology port images(s)
Neutron beam tx simple
Neutron beam tx complex
Io rad tx delivery by x-ray
Io rad tx deliver by elctrns
Radiation tx management x5
Radiation therapy management
Stereotactic radiation trmt
Sbrt management
Io radiation tx management
Special radiation treatment
Special radiation treatment
Special radiation treatment
Radiation therapy management
Radiation therapy management
Radiation therapy management
Proton trmt simple w/o comp
Proton trmt simple w/comp
Proton trmt intermediate
Proton treatment complex
Hyperthermia treatment
Hyperthermia treatment
$153.08
$64.32
$88.76
$77.26
$508.46
$223.51
$284.95
$117.50
$0.00
$1,068.30
$1,356.49
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$20.84
$0.00
$0.00
$0.00
$10.78
$33.78
$65.76
$0.00
$0.00
$187.57
$102.77
$420.78
$634.94
$323.76
$156.67
$108.88
$47.79
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$406.05
$81.21
Page 34 of 45
2016
Payment
Rate
$154.06
$64.85
$89.21
$80.25
$513.06
$224.28
$288.77
$122.89
$0.00
$1,083.79
$1,377.22
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$24.72
$0.00
$0.00
$0.00
$11.11
$0.00
$0.00
$0.00
$0.00
$187.74
$103.18
$422.41
$637.38
$325.68
$158.00
$109.28
$48.73
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$425.64
$83.12
Percent
Change in
Payment Rate
0.6%
0.8%
0.5%
3.9%
0.9%
0.3%
1.3%
4.6%
1.5%
1.5%
18.6%
3.0%
-100.0%
-100.0%
0.1%
0.4%
0.4%
0.4%
0.6%
0.8%
0.4%
2.0%
4.8%
2.4%
CPT
Code
77600
77605
77605
77605
77610
77610
77610
77615
77615
77615
77620
77620
77620
77750
77750
77750
77761
77761
77761
77762
77762
77762
77763
77763
77763
77767
77767
77767
77768
77768
77768
77770
77770
77770
77771
77771
77771
77772
77772
77772
77778
77778
77778
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Hyperthermia treatment
Infuse radioactive materials
Infuse radioactive materials
Infuse radioactive materials
Apply intrcav radiat simple
Apply intrcav radiat simple
Apply intrcav radiat simple
Apply intrcav radiat interm
Apply intrcav radiat interm
Apply intrcav radiat interm
Apply intrcav radiat compl
Apply intrcav radiat compl
Apply intrcav radiat compl
Hdr rdncl skn surf brachytx
Hdr rdncl skn surf brachytx
Hdr rdncl skn surf brachytx
Hdr rdncl skn surf brachytx
Hdr rdncl skn surf brachytx
Hdr rdncl skn surf brachytx
Hdr rdncl ntrstl/icav brchtx
Hdr rdncl ntrstl/icav brchtx
Hdr rdncl ntrstl/icav brchtx
Hdr rdncl ntrstl/icav brchtx
Hdr rdncl ntrstl/icav brchtx
Hdr rdncl ntrstl/icav brchtx
Hdr rdncl ntrstl/icav brchtx
Hdr rdncl ntrstl/icav brchtx
Hdr rdncl ntrstl/icav brchtx
Apply interstit radiat compl
Apply interstit radiat compl
Apply interstit radiat compl
2015
Payment
Rate
$324.84
$768.62
$108.16
$660.46
$1,036.68
$78.69
$957.99
$1,018.71
$108.88
$909.84
$468.57
$88.76
$379.82
$373.35
$260.52
$112.83
$390.60
$198.35
$192.24
$551.94
$330.59
$221.35
$736.28
$450.25
$286.03
$877.86
$587.15
$290.70
Page 35 of 45
2016
Payment
Rate
$342.51
$808.99
$117.87
$691.12
$1,004.97
$87.42
$917.55
$1,074.12
$108.92
$965.20
$387.66
$81.69
$305.97
$375.12
$260.83
$114.29
$393.39
$198.84
$194.55
$523.45
$300.24
$223.21
$741.28
$452.51
$288.77
$227.15
$55.18
$171.97
$355.77
$73.09
$282.68
$324.24
$101.75
$222.49
$604.06
$198.84
$405.21
$921.49
$281.97
$639.53
$788.57
$416.68
$371.89
Percent
Change in
Payment Rate
5.4%
5.3%
9.0%
4.6%
-3.1%
11.1%
-4.2%
5.4%
0.0%
6.1%
-17.3%
-8.0%
-19.4%
0.5%
0.1%
1.3%
0.7%
0.2%
1.2%
-5.2%
-9.2%
0.8%
0.7%
0.5%
1.0%
-10.2%
-29.0%
27.9%
CPT
Code
77789
77789
77789
77790
77799
77799
77799
78012
78012
78012
78013
78013
78013
78014
78014
78014
78015
78015
78015
78016
78016
78016
78018
78018
78018
78020
78020
78020
78070
78070
78070
78071
78071
78071
78072
78072
78072
78075
78075
78075
78099
78099
78099
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Apply surf ldr radionuclide
Apply surface radiation
Apply surface radiation
Radiation handling
Radium/radioisotope therapy
Radium/radioisotope therapy
Radium/radioisotope therapy
Thyroid uptake measurement
Thyroid uptake measurement
Thyroid uptake measurement
Thyroid imaging w/blood flow
Thyroid imaging w/blood flow
Thyroid imaging w/blood flow
Thyroid imaging w/blood flow
Thyroid imaging w/blood flow
Thyroid imaging w/blood flow
Thyroid met imaging
Thyroid met imaging
Thyroid met imaging
Thyroid met imaging/studies
Thyroid met imaging/studies
Thyroid met imaging/studies
Thyroid met imaging body
Thyroid met imaging body
Thyroid met imaging body
Thyroid met uptake
Thyroid met uptake
Thyroid met uptake
Parathyroid planar imaging
Parathyroid planar imaging
Parathyroid planar imaging
Parathyrd planar w/wo subtrj
Parathyrd planar w/wo subtrj
Parathyrd planar w/wo subtrj
Parathyrd planar w/spect&ct
Parathyrd planar w/spect&ct
Parathyrd planar w/spect&ct
Adrenal cortex & medulla img
Adrenal cortex & medulla img
Adrenal cortex & medulla img
Endocrine nuclear procedure
Endocrine nuclear procedure
Endocrine nuclear procedure
$119.66
$59.29
$60.37
$97.38
$0.00
$0.00
$0.00
$83.01
$9.70
$73.30
$197.99
$18.33
$179.67
$251.18
$24.79
$226.38
$229.62
$33.06
$196.56
$295.01
$35.21
$259.80
$324.84
$42.04
$282.80
$86.96
$28.39
$58.57
$313.34
$40.25
$273.09
$373.35
$60.01
$313.34
$427.25
$77.98
$349.27
$471.81
$38.09
$433.72
$0.00
$0.00
$0.00
Page 36 of 45
2016
Payment
Rate
$121.46
$60.19
$61.27
$15.05
$0.00
$0.00
$0.00
$82.40
$9.67
$72.73
$198.49
$18.63
$179.86
$251.51
$25.08
$226.43
$229.30
$33.32
$195.98
$290.21
$34.75
$255.45
$324.96
$41.92
$283.04
$86.70
$28.30
$58.40
$311.70
$39.77
$271.93
$372.61
$59.47
$313.14
$430.29
$78.10
$352.19
$445.34
$35.83
$409.51
$0.00
$0.00
$0.00
Percent
Change in
Payment Rate
1.5%
1.5%
1.5%
-84.5%
-0.7%
-0.3%
-0.8%
0.2%
1.7%
0.1%
0.1%
1.2%
0.0%
-0.1%
0.8%
-0.3%
-1.6%
-1.3%
-1.7%
0.0%
-0.3%
0.1%
-0.3%
-0.3%
-0.3%
-0.5%
-1.2%
-0.4%
-0.2%
-0.9%
-0.1%
0.7%
0.2%
0.8%
-5.6%
-5.9%
-5.6%
CPT
Code
78102
78102
78102
78103
78103
78103
78104
78104
78104
78110
78110
78110
78111
78111
78111
78120
78120
78120
78121
78121
78121
78122
78122
78122
78130
78130
78130
78135
78135
78135
78140
78140
78140
78185
78185
78185
78190
78190
78190
78191
78191
78191
78195
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Bone marrow imaging ltd
Bone marrow imaging ltd
Bone marrow imaging ltd
Bone marrow imaging mult
Bone marrow imaging mult
Bone marrow imaging mult
Bone marrow imaging body
Bone marrow imaging body
Bone marrow imaging body
Plasma volume single
Plasma volume single
Plasma volume single
Plasma volume multiple
Plasma volume multiple
Plasma volume multiple
Red cell mass single
Red cell mass single
Red cell mass single
Red cell mass multiple
Red cell mass multiple
Red cell mass multiple
Blood volume
Blood volume
Blood volume
Red cell survival study
Red cell survival study
Red cell survival study
Red cell survival kinetics
Red cell survival kinetics
Red cell survival kinetics
Red cell sequestration
Red cell sequestration
Red cell sequestration
Spleen imaging
Spleen imaging
Spleen imaging
Platelet survival kinetics
Platelet survival kinetics
Platelet survival kinetics
Platelet survival
Platelet survival
Platelet survival
Lymph system imaging
$176.79
$27.31
$149.48
$229.97
$35.93
$194.04
$255.13
$38.45
$216.68
$107.08
$10.06
$97.02
$100.25
$11.14
$89.12
$97.74
$11.86
$85.88
$109.60
$16.17
$93.43
$99.90
$21.20
$78.69
$163.86
$29.47
$134.39
$365.80
$33.06
$332.74
$141.22
$30.54
$110.68
$220.99
$20.48
$200.51
$335.62
$55.70
$279.92
$173.56
$31.62
$141.94
$371.19
Page 37 of 45
2016
Payment
Rate
$176.27
$26.87
$149.40
$231.45
$36.90
$194.55
$255.09
$39.05
$216.04
$97.45
$9.67
$87.78
$99.96
$11.11
$88.85
$97.45
$11.82
$85.63
$106.05
$16.48
$89.57
$101.75
$21.86
$79.90
$175.20
$30.81
$144.39
$364.37
$32.60
$331.77
$141.52
$31.17
$110.35
$220.34
$20.42
$199.92
$410.23
$55.18
$355.05
$175.20
$30.81
$144.39
$370.46
Percent
Change in
Payment Rate
-0.3%
-1.6%
-0.1%
0.6%
2.7%
0.3%
-0.0%
1.6%
-0.3%
-9.0%
-3.9%
-9.5%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-3.2%
1.9%
-4.1%
1.9%
3.1%
1.5%
6.9%
4.6%
7.4%
-0.4%
-1.4%
-0.3%
0.2%
2.1%
-0.3%
-0.3%
-0.3%
-0.3%
22.2%
-0.9%
26.8%
0.9%
-2.6%
1.7%
-0.2%
CPT
Code
78195
78195
78199
78199
78199
78201
78201
78201
78202
78202
78202
78205
78205
78205
78206
78206
78206
78215
78215
78215
78216
78216
78216
78226
78226
78226
78227
78227
78227
78230
78230
78230
78231
78231
78231
78232
78232
78232
78258
78258
78258
78261
78261
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
Description
2015
Payment
Rate
Lymph system imaging
Lymph system imaging
Blood/lymph nuclear exam
Blood/lymph nuclear exam
Blood/lymph nuclear exam
Liver imaging
Liver imaging
Liver imaging
Liver imaging with flow
Liver imaging with flow
Liver imaging with flow
Liver imaging (3d)
Liver imaging (3d)
Liver imaging (3d)
Liver image (3d) with flow
Liver image (3d) with flow
Liver image (3d) with flow
Liver and spleen imaging
Liver and spleen imaging
Liver and spleen imaging
Liver & spleen image/flow
Liver & spleen image/flow
Liver & spleen image/flow
Hepatobiliary system imaging
Hepatobiliary system imaging
Hepatobiliary system imaging
Hepatobil syst image w/drug
Hepatobil syst image w/drug
Hepatobil syst image w/drug
Salivary gland imaging
Salivary gland imaging
Salivary gland imaging
Serial salivary imaging
Serial salivary imaging
Serial salivary imaging
Salivary gland function exam
Salivary gland function exam
Salivary gland function exam
Esophageal motility study
Esophageal motility study
Esophageal motility study
Gastric mucosa imaging
Gastric mucosa imaging
$60.01
$311.18
$0.00
$0.00
$0.00
$196.20
$21.92
$174.28
$209.13
$24.08
$185.06
$219.19
$34.50
$184.70
$358.26
$48.15
$310.11
$202.31
$24.43
$177.87
$130.80
$28.39
$102.41
$345.68
$37.37
$308.31
$418.27
$45.28
$372.99
$180.03
$22.64
$157.39
$134.75
$26.23
$108.52
$102.77
$20.84
$81.93
$229.26
$36.65
$192.60
$263.75
$35.57
Page 38 of 45
2016
Payment
Rate
$59.83
$310.63
$0.00
$0.00
$0.00
$195.26
$21.50
$173.77
$209.95
$24.36
$185.59
$220.34
$34.39
$185.95
$356.85
$47.65
$309.19
$202.79
$24.72
$178.06
$130.41
$27.95
$102.47
$345.38
$37.26
$308.12
$377.27
$45.50
$331.77
$146.54
$19.35
$127.19
$135.07
$26.51
$108.56
$102.47
$20.06
$82.40
$230.73
$37.26
$193.47
$258.68
$34.75
Percent
Change in
Payment Rate
-0.3%
-0.2%
-0.5%
-1.9%
-0.3%
0.4%
1.2%
0.3%
0.5%
-0.3%
0.7%
-0.4%
-1.0%
-0.3%
0.2%
1.2%
0.1%
-0.3%
-1.6%
0.1%
-0.1%
-0.3%
-0.1%
-9.8%
0.5%
-11.1%
-18.6%
-14.5%
-19.2%
0.2%
1.1%
0.0%
-0.3%
-3.7%
0.6%
0.6%
1.7%
0.5%
-1.9%
-2.3%
CPT
Code
78261
78262
78262
78262
78264
78264
78264
78265
78265
78265
78266
78266
78266
78267
78268
78270
78270
78270
78271
78271
78271
78272
78272
78272
78278
78278
78278
78282
78282
78282
78290
78290
78290
78291
78291
78291
78299
78299
78299
78300
78300
78300
78305
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
2015
Payment
Rate
Description
Gastric mucosa imaging
Gastroesophageal reflux exam
Gastroesophageal reflux exam
Gastroesophageal reflux exam
Gastric emptying imag study
Gastric emptying study
Gastric emptying study
Gastric emptying imag study
Gastric emptying imag study
Gastric emptying imag study
Gastric emptying imag study
Gastric emptying imag study
Gastric emptying imag study
Breath tst attain/anal c-14
Breath test analysis c-14
Vit b-12 absorption exam
Vit b-12 absorption exam
Vit b-12 absorption exam
Vit b-12 absrp exam int fac
Vit b-12 absrp exam int fac
Vit b-12 absrp exam int fac
Vit b-12 absorp combined
Vit b-12 absorp combined
Vit b-12 absorp combined
Acute gi blood loss imaging
Acute gi blood loss imaging
Acute gi blood loss imaging
Gi protein loss exam
Gi protein loss exam
Gi protein loss exam
Meckels divert exam
Meckels divert exam
Meckels divert exam
Leveen/shunt patency exam
Leveen/shunt patency exam
Leveen/shunt patency exam
Gi nuclear procedure
Gi nuclear procedure
Gi nuclear procedure
Bone imaging limited area
Bone imaging limited area
Bone imaging limited area
Bone imaging multiple areas
Page 39 of 45
$228.18
$254.05
$33.78
$220.27
$301.84
$40.25
$261.60
$0.00
$0.00
$105.64
$10.78
$94.86
$94.15
$10.42
$83.73
$100.97
$13.65
$87.32
$364.37
$50.31
$314.06
$0.00
$19.76
$0.00
$347.12
$34.50
$312.62
$259.44
$43.12
$216.32
$0.00
$0.00
$0.00
$187.93
$31.98
$155.95
$240.40
2016
Payment
Rate
$223.92
$254.38
$33.68
$220.70
$348.61
$37.26
$311.34
$380.85
$49.08
$331.77
$492.99
$54.46
$438.53
$0.00
$0.00
$104.98
$10.75
$94.23
$94.23
$10.39
$83.84
$100.68
$13.61
$87.06
$363.29
$49.80
$313.49
$0.00
$19.35
$0.00
$347.53
$34.39
$313.14
$262.26
$42.99
$219.27
$0.00
$0.00
$0.00
$188.45
$31.89
$156.57
$240.76
Percent
Change in
Payment Rate
-1.9%
0.1%
-0.3%
0.2%
15.5%
-7.4%
19.0%
-0.6%
-0.3%
-0.7%
0.1%
-0.3%
0.1%
-0.3%
-0.3%
-0.3%
-0.3%
-1.0%
-0.2%
-2.1%
0.1%
-0.3%
0.2%
1.1%
-0.3%
1.4%
0.3%
-0.3%
0.4%
0.2%
CPT
Code
78305
78305
78306
78306
78306
78315
78315
78315
78320
78320
78320
78350
78350
78350
78351
78399
78399
78399
78414
78414
78414
78428
78428
78428
78445
78445
78445
78451
78451
78451
78452
78452
78452
78453
78453
78453
78454
78454
78454
78456
78456
78456
78457
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
2015
Payment
Rate
Description
Bone imaging multiple areas
Bone imaging multiple areas
Bone imaging whole body
Bone imaging whole body
Bone imaging whole body
Bone imaging 3 phase
Bone imaging 3 phase
Bone imaging 3 phase
Bone imaging (3d)
Bone imaging (3d)
Bone imaging (3d)
Bone mineral single photon
Bone mineral single photon
Bone mineral single photon
Bone mineral dual photon
Musculoskeletal nuclear exam
Musculoskeletal nuclear exam
Musculoskeletal nuclear exam
Non-imaging heart function
Non-imaging heart function
Non-imaging heart function
Cardiac shunt imaging
Cardiac shunt imaging
Cardiac shunt imaging
Vascular flow imaging
Vascular flow imaging
Vascular flow imaging
Ht muscle image spect sing
Ht muscle image spect sing
Ht muscle image spect sing
Ht muscle image spect mult
Ht muscle image spect mult
Ht muscle image spect mult
Ht muscle image planar sing
Ht muscle image planar sing
Ht muscle image planar sing
Ht musc image planar mult
Ht musc image planar mult
Ht musc image planar mult
Acute venous thrombus image
Acute venous thrombus image
Acute venous thrombus image
Venous thrombosis imaging
Page 40 of 45
$41.68
$198.71
$262.67
$43.12
$219.55
$362.21
$51.38
$310.82
$237.52
$51.38
$186.14
$33.42
$11.14
$22.28
$15.45
$0.00
$0.00
$0.00
$0.00
$23.00
$0.00
$188.29
$38.45
$149.84
$187.21
$24.08
$163.14
$355.74
$68.27
$287.47
$492.65
$80.49
$412.16
$317.29
$49.95
$267.35
$454.20
$67.56
$386.64
$334.18
$49.59
$284.59
$182.54
2016
Payment
Rate
$41.92
$198.84
$262.98
$43.35
$219.63
$361.15
$50.88
$310.27
$236.82
$51.23
$185.59
$33.32
$11.11
$22.21
$15.41
$0.00
$0.00
$0.00
$0.00
$22.57
$0.00
$187.38
$38.34
$149.04
$182.01
$23.65
$158.36
$354.70
$68.07
$286.62
$492.28
$80.25
$412.02
$316.36
$50.16
$266.20
$455.01
$67.71
$387.30
$328.90
$49.44
$279.46
$195.62
Percent
Change in
Payment Rate
0.6%
0.1%
0.1%
0.5%
0.0%
-0.3%
-1.0%
-0.2%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-1.9%
-0.5%
-0.3%
-0.5%
-2.8%
-1.8%
-2.9%
-0.3%
-0.3%
-0.3%
-0.1%
-0.3%
-0.0%
-0.3%
0.4%
-0.4%
0.2%
0.2%
0.2%
-1.6%
-0.3%
-1.8%
7.2%
CPT
Code
78457
78457
78458
78458
78458
78459
78459
78459
78466
78466
78466
78468
78468
78468
78469
78469
78469
78472
78472
78472
78473
78473
78473
78481
78481
78481
78483
78483
78483
78491
78491
78491
78492
78492
78492
78494
78494
78494
78496
78496
78496
78499
78499
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
Description
2015
Payment
Rate
Venous thrombosis imaging
Venous thrombosis imaging
Ven thrombosis images bilat
Ven thrombosis images bilat
Ven thrombosis images bilat
Heart muscle imaging (pet)
Heart muscle imaging (pet)
Heart muscle imaging (pet)
Heart infarct image
Heart infarct image
Heart infarct image
Heart infarct image (ef)
Heart infarct image (ef)
Heart infarct image (ef)
Heart infarct image (3d)
Heart infarct image (3d)
Heart infarct image (3d)
Gated heart planar single
Gated heart planar single
Gated heart planar single
Gated heart multiple
Gated heart multiple
Gated heart multiple
Heart first pass single
Heart first pass single
Heart first pass single
Heart first pass multiple
Heart first pass multiple
Heart first pass multiple
Heart image (pet) single
Heart image (pet) single
Heart image (pet) single
Heart image (pet) multiple
Heart image (pet) multiple
Heart image (pet) multiple
Heart image spect
Heart image spect
Heart image spect
Heart first pass add-on
Heart first pass add-on
Heart first pass add-on
Cardiovascular nuclear exam
Cardiovascular nuclear exam
$38.09
$144.45
$213.80
$45.64
$168.17
$0.00
$74.02
$0.00
$203.02
$35.57
$167.45
$201.23
$39.53
$161.70
$237.16
$46.35
$190.81
$239.68
$48.87
$190.81
$300.76
$72.23
$228.54
$181.82
$48.51
$133.31
$247.58
$72.59
$175.00
$0.00
$74.38
$0.00
$0.00
$93.43
$0.00
$233.21
$58.93
$174.28
$45.99
$24.79
$21.20
$0.00
$0.00
Page 41 of 45
2016
Payment
Rate
$39.05
$156.57
$173.77
$38.34
$135.43
$0.00
$71.66
$0.00
$200.99
$35.47
$165.52
$205.65
$39.77
$165.88
$236.46
$46.22
$190.25
$238.97
$48.73
$190.25
$300.60
$72.37
$228.22
$180.93
$48.37
$132.56
$250.80
$72.37
$178.42
$0.00
$72.37
$0.00
$0.00
$91.00
$0.00
$233.24
$58.76
$174.48
$45.50
$24.72
$20.78
$0.00
$0.00
Percent
Change in
Payment Rate
2.5%
8.4%
-18.7%
-16.0%
-19.5%
-3.2%
-1.0%
-0.3%
-1.1%
2.2%
0.6%
2.6%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.3%
-0.1%
0.2%
-0.1%
-0.5%
-0.3%
-0.6%
1.3%
-0.3%
2.0%
-2.7%
-2.6%
0.0%
-0.3%
0.1%
-1.1%
-0.3%
-2.0%
CPT
Code
78499
78579
78579
78579
78580
78580
78580
78582
78582
78582
78597
78597
78597
78598
78598
78598
78599
78599
78599
78600
78600
78600
78601
78601
78601
78605
78605
78605
78606
78606
78606
78607
78607
78607
78608
78608
78608
78609
78609
78609
78610
78610
78610
Modifier
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Cardiovascular nuclear exam
Lung ventilation imaging
Lung ventilation imaging
Lung ventilation imaging
Lung perfusion imaging
Lung perfusion imaging
Lung perfusion imaging
Lung ventilat&perfus imaging
Lung ventilat&perfus imaging
Lung ventilat&perfus imaging
Lung perfusion differential
Lung perfusion differential
Lung perfusion differential
Lung perf&ventilat diferentl
Lung perf&ventilat diferentl
Lung perf&ventilat diferentl
Respiratory nuclear exam
Respiratory nuclear exam
Respiratory nuclear exam
Brain image < 4 views
Brain image < 4 views
Brain image < 4 views
Brain image w/flow < 4 views
Brain image w/flow < 4 views
Brain image w/flow < 4 views
Brain image 4+ views
Brain image 4+ views
Brain image 4+ views
Brain image w/flow 4 + views
Brain image w/flow 4 + views
Brain image w/flow 4 + views
Brain imaging (3d)
Brain imaging (3d)
Brain imaging (3d)
Brain imaging (pet)
Brain imaging (pet)
Brain imaging (pet)
Brain imaging (pet)
Brain imaging (pet)
Brain imaging (pet)
Brain flow imaging only
Brain flow imaging only
Brain flow imaging only
$0.00
$192.24
$23.72
$168.53
$248.66
$37.01
$211.65
$349.27
$53.90
$295.37
$210.57
$36.65
$173.92
$319.45
$42.40
$277.05
$0.00
$0.00
$0.00
$191.88
$22.28
$169.61
$223.87
$25.51
$198.35
$206.98
$26.95
$180.03
$347.12
$31.98
$315.14
$367.60
$60.37
$307.23
$0.00
$75.10
$0.00
$77.98
$77.98
$0.00
$181.46
$15.09
$166.37
Page 42 of 45
2016
Payment
Rate
$0.00
$194.19
$24.00
$170.18
$249.36
$37.26
$212.10
$348.96
$53.74
$295.22
$210.31
$36.19
$174.12
$319.58
$42.28
$277.31
$0.00
$0.00
$0.00
$192.40
$22.57
$169.82
$222.85
$25.44
$197.41
$207.44
$27.23
$180.21
$344.66
$31.89
$312.78
$365.44
$60.19
$305.25
$0.00
$73.09
$0.00
$75.60
$75.60
$0.00
$182.01
$15.41
$166.60
Percent
Change in
Payment Rate
1.0%
1.2%
1.0%
0.3%
0.7%
0.2%
-0.1%
-0.3%
-0.1%
-0.1%
-1.3%
0.1%
0.0%
-0.3%
0.1%
0.3%
1.3%
0.1%
-0.5%
-0.3%
-0.5%
0.2%
1.0%
0.1%
-0.7%
-0.3%
-0.7%
-0.6%
-0.3%
-0.6%
-2.7%
-3.1%
-3.1%
0.3%
2.1%
0.1%
CPT
Code
78630
78630
78630
78635
78635
78635
78645
78645
78645
78647
78647
78647
78650
78650
78650
78660
78660
78660
78699
78699
78699
78700
78700
78700
78701
78701
78701
78707
78707
78707
78708
78708
78708
78709
78709
78709
78710
78710
78710
78725
78725
78725
78730
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Cerebrospinal fluid scan
Cerebrospinal fluid scan
Cerebrospinal fluid scan
Csf ventriculography
Csf ventriculography
Csf ventriculography
Csf shunt evaluation
Csf shunt evaluation
Csf shunt evaluation
Cerebrospinal fluid scan
Cerebrospinal fluid scan
Cerebrospinal fluid scan
Csf leakage imaging
Csf leakage imaging
Csf leakage imaging
Nuclear exam of tear flow
Nuclear exam of tear flow
Nuclear exam of tear flow
Nervous system nuclear exam
Nervous system nuclear exam
Nervous system nuclear exam
Kidney imaging morphol
Kidney imaging morphol
Kidney imaging morphol
Kidney imaging with flow
Kidney imaging with flow
Kidney imaging with flow
K flow/funct image w/o drug
K flow/funct image w/o drug
K flow/funct image w/o drug
K flow/funct image w/drug
K flow/funct image w/drug
K flow/funct image w/drug
K flow/funct image multiple
K flow/funct image multiple
K flow/funct image multiple
Kidney imaging (3d)
Kidney imaging (3d)
Kidney imaging (3d)
Kidney function study
Kidney function study
Kidney function study
Urinary bladder retention
$354.30
$34.50
$319.81
$355.38
$31.62
$323.76
$337.77
$28.39
$309.39
$366.16
$44.92
$321.25
$348.56
$30.90
$317.65
$183.62
$26.23
$157.39
$0.00
$0.00
$0.00
$178.59
$22.28
$156.31
$219.19
$24.08
$195.12
$241.83
$47.43
$194.40
$180.75
$60.73
$120.02
$376.58
$68.99
$307.59
$205.90
$30.18
$175.71
$112.47
$18.33
$94.15
$79.77
Page 43 of 45
2016
Payment
Rate
$352.90
$34.39
$318.51
$353.26
$31.17
$322.09
$336.42
$28.30
$308.12
$364.73
$45.86
$318.87
$343.23
$30.45
$312.78
$187.74
$27.23
$160.51
$0.00
$0.00
$0.00
$179.14
$22.57
$156.57
$219.63
$24.00
$195.62
$241.84
$47.65
$194.19
$180.57
$60.19
$120.38
$378.34
$69.51
$308.84
$208.16
$31.17
$176.99
$112.14
$18.63
$93.51
$79.54
Percent
Change in
Payment Rate
-0.4%
-0.3%
-0.4%
-0.6%
-1.4%
-0.5%
-0.4%
-0.3%
-0.4%
-0.4%
2.1%
-0.7%
-1.5%
-1.5%
-1.5%
2.2%
3.8%
2.0%
0.3%
1.3%
0.2%
0.2%
-0.3%
0.3%
0.0%
0.5%
-0.1%
-0.1%
-0.9%
0.3%
0.5%
0.7%
0.4%
1.1%
3.3%
0.7%
-0.3%
1.7%
-0.7%
-0.3%
CPT
Code
78730
78730
78740
78740
78740
78761
78761
78761
78799
78799
78799
78800
78800
78800
78801
78801
78801
78802
78802
78802
78803
78803
78803
78804
78804
78804
78805
78805
78805
78806
78806
78806
78807
78807
78807
78808
78811
78811
78811
78812
78812
78812
78813
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Urinary bladder retention
Urinary bladder retention
Ureteral reflux study
Ureteral reflux study
Ureteral reflux study
Testicular imaging w/flow
Testicular imaging w/flow
Testicular imaging w/flow
Genitourinary nuclear exam
Genitourinary nuclear exam
Genitourinary nuclear exam
Tumor imaging limited area
Tumor imaging limited area
Tumor imaging limited area
Tumor imaging mult areas
Tumor imaging mult areas
Tumor imaging mult areas
Tumor imaging whole body
Tumor imaging whole body
Tumor imaging whole body
Tumor imaging (3d)
Tumor imaging (3d)
Tumor imaging (3d)
Tumor imaging whole body
Tumor imaging whole body
Tumor imaging whole body
Abscess imaging ltd area
Abscess imaging ltd area
Abscess imaging ltd area
Abscess imaging whole body
Abscess imaging whole body
Abscess imaging whole body
Nuclear localization/abscess
Nuclear localization/abscess
Nuclear localization/abscess
Iv inj ra drug dx study
Pet image ltd area
Pet image ltd area
Pet image ltd area
Pet image skull-thigh
Pet image skull-thigh
Pet image skull-thigh
Pet image full body
$7.91
$71.87
$227.82
$28.39
$199.43
$219.55
$36.65
$182.90
$0.00
$0.00
$0.00
$198.35
$33.78
$164.58
$271.30
$40.60
$230.69
$338.49
$43.12
$295.37
$355.38
$53.18
$302.20
$594.70
$53.18
$541.52
$189.37
$36.65
$152.72
$347.84
$42.76
$305.08
$355.74
$52.46
$303.28
$45.64
$0.00
$80.49
$0.00
$0.00
$98.82
$0.00
$0.00
Page 44 of 45
2016
Payment
Rate
$7.88
$71.66
$226.79
$27.95
$198.84
$217.12
$36.19
$180.93
$0.00
$0.00
$0.00
$199.20
$34.39
$164.81
$271.93
$40.84
$231.09
$338.57
$42.64
$295.94
$354.34
$52.67
$301.67
$590.44
$52.67
$537.78
$189.53
$36.54
$152.99
$346.46
$42.64
$303.82
$353.98
$52.67
$301.31
$46.93
$0.00
$78.46
$0.00
$0.00
$95.66
$0.00
$0.00
Percent
Change in
Payment Rate
-0.3%
-0.3%
-0.5%
-1.6%
-0.3%
-1.1%
-1.3%
-1.1%
0.4%
1.8%
0.1%
0.2%
0.6%
0.2%
0.0%
-1.1%
0.2%
-0.3%
-1.0%
-0.2%
-0.7%
-1.0%
-0.7%
0.1%
-0.3%
0.2%
-0.4%
-0.3%
-0.4%
-0.5%
0.4%
-0.6%
2.8%
-2.5%
-3.2%
CPT
Code
78813
78813
78814
78814
78814
78815
78815
78815
78816
78816
78816
78999
78999
78999
79005
79005
79005
79101
79101
79101
79200
79200
79200
79300
79300
79300
79403
79403
79403
79440
79440
79440
79445
79445
79445
79999
79999
79999
Modifier
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Description
2015
Payment
Rate
Pet image full body
Pet image full body
Pet image w/ct lmtd
Pet image w/ct lmtd
Pet image w/ct lmtd
Pet image w/ct skull-thigh
Pet image w/ct skull-thigh
Pet image w/ct skull-thigh
Pet image w/ct full body
Pet image w/ct full body
Pet image w/ct full body
Nuclear diagnostic exam
Nuclear diagnostic exam
Nuclear diagnostic exam
Nuclear rx oral admin
Nuclear rx oral admin
Nuclear rx oral admin
Nuclear rx iv admin
Nuclear rx iv admin
Nuclear rx iv admin
Nuclear rx intracav admin
Nuclear rx intracav admin
Nuclear rx intracav admin
Nuclr rx interstit colloid
Nuclr rx interstit colloid
Nuclr rx interstit colloid
Hematopoietic nuclear tx
Hematopoietic nuclear tx
Hematopoietic nuclear tx
Nuclear rx intra-articular
Nuclear rx intra-articular
Nuclear rx intra-articular
Nuclear rx intra-arterial
Nuclear rx intra-arterial
Nuclear rx intra-arterial
Nuclear medicine therapy
Nuclear medicine therapy
Nuclear medicine therapy
$103.13
$0.00
$0.00
$114.63
$0.00
$0.00
$125.77
$0.00
$0.00
$126.49
$0.00
$0.00
$0.00
$0.00
$138.70
$89.12
$49.59
$144.81
$96.30
$48.51
$137.98
$85.52
$52.46
$0.00
$73.66
$0.00
$193.32
$111.75
$81.57
$130.80
$90.19
$40.60
$0.00
$121.10
$0.00
$0.00
$0.00
$0.00
Page 45 of 45
2016
Payment
Rate
$99.60
$0.00
$0.00
$110.35
$0.00
$0.00
$121.46
$0.00
$0.00
$122.53
$0.00
$0.00
$0.00
$0.00
$139.01
$89.21
$49.80
$145.10
$96.74
$48.37
$162.66
$103.54
$59.12
$0.00
$80.97
$0.00
$195.98
$112.86
$83.12
$147.25
$96.38
$50.88
$0.00
$117.16
$0.00
$0.00
$0.00
$0.00
Percent
Change in
Payment Rate
-3.4%
-3.7%
-3.4%
-3.1%
0.2%
0.1%
0.4%
0.2%
0.5%
-0.3%
17.9%
21.1%
12.7%
9.9%
1.4%
1.0%
1.9%
12.6%
6.9%
25.3%
-3.3%