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| RADIOLOGY ABN FEE SCHEDULE |
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| CHARGES EFFECTIVE 10/01/07 |
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| Test Name |
CPT |
CDM Code |
Fee |
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| CT - HEAD/BRAIN
WO CONTRAST |
70450 |
4247582 |
$1,228.00 |
| CT - HEAD/BRAIN
W CONTRAST |
70460 |
4247583 |
$1,228.00 |
| CT - HEAD/BRAIN
W & WO CONTRAST |
70470 |
4247584 |
$1,730.50 |
| MRA; HEAD; WO
CONTRAST |
70544 |
4197412 |
$1,614.70 |
| MRA; HEAD W
CONTRAST |
70545 |
4197413 |
$1,717.30 |
| MRA; HEAD W
& WO CONTRAST |
70546 |
4197414 |
$2,134.40 |
| MRA; NECK WO
CONTRAST |
70547 |
4197415 |
$1,614.70 |
| MRA; NECK W
CONTRAST |
70548 |
4197416 |
$1,717.30 |
| MRA; NECK W
& WO CONTRAST |
70549 |
4197417 |
$2,134.40 |
| MRA, ABD W
CONTRAST |
C8900 |
4197300 |
$1,614.70 |
| MRA, ABD WO
CONTRAST |
C8901 |
4197301 |
$1,614.70 |
| MRA ABD W/WO
CONTRAST |
C8902 |
4197302 |
$1,614.70 |
| PELVIS MRA W
CONTR |
C8918 |
4197321 |
$1,614.70 |
| PELVIS MRA WO
CONTR |
C8919 |
4197322 |
$1,614.70 |
| PELVIS MRA W
& WO CONTR |
C8920 |
4197323 |
$1,614.70
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