Diagnostic radiology OHIP billing codes

General Listings

Code	Description	Amount	Ans Units	Assist Units
A335	Consultation	$50.00	N/A	N/A
A365	Special interventional radiological consultation	$223.20	N/A	N/A
A330	Radiology second opinion of CT study, per study	$89.50	N/A	N/A
A332	Radiology second opinion of MRI study, per study	$199.70	N/A	N/A
A331	Minor assessment	$17.75	N/A	N/A
A338	Minor assessment	$17.75	N/A	N/A

Angiography

Code	Description	Amount	Ans Units	Assist Units
J021	By catheterization - abdominal, thoracic, cervical or cranial - insertion of catheter (including cut down, if necessary) and injection, if given	$121.40	6	N/A
J022	By catheterization - abdominal, thoracic, cervical or cranial - selective catheterization - add to catheter insertion fee (per vessel, to maximum of 4) … add	$60.15	N/A	N/A
J014	By catheterization - abdominal, thoracic, cervical or cranial - selective catheterization - selective catheterization for spinal and parathyroid angiography - add to catheter insertion fee	$38.05	N/A	N/A
J056	By catheterization - abdominal, thoracic, cervical or cranial - selective catheterization - transcatheter fibrinolytic therapy	$582.45	7	N/A
J058	Vascular stenting	$101.55	6	N/A
J066	Renal angioplasty	$438.10	6	N/A
J031	Carotid angiogram - direct puncture	$89.90	6	N/A
J025	Transluminal angioplasty including angiography (if anatomy is known), with or without pressure measurements - one or more site(s) or vessel(s)	$398.15	6	N/A
J067	Spinal angiography for AV malformation, per vessel, maximum of 12 vessels per side	$38.20	6	N/A
J048	Percutaneous trans-hepatic catheter portal venography	$311.05	6	N/A
J027	Peripheral arteriogram - direct puncture	$76.55	6	N/A
J026	Peripheral venogram - direct puncture	$61.50	6	N/A
J033	Splenoportogram	$111.50	6	N/A
J034	Trans-lumbar aortogram	$89.90	6	N/A
J032	Vertebral angiogram - direct puncture or by retrograde brachial injection	$111.50	6	N/A
J040	Embolization (e.g. for treatment of haemangioma or renal carcinoma) - first vessel, claim appropriate angiographic procedural and radiological fees plus	$105.30	N/A	N/A
J047	- each additional vessel catheterized and occluded per vessel	$49.35	N/A	N/A
J023	Intra-arterial infusion of drugs e.g. for control of gastrointestinal haemorrhage - claim appropriate angiographic procedural and radiological fees plus a per diem supervision fee of	$29.55	N/A	N/A
J035	Pressure measurements during angiography	$29.55	N/A	N/A

Miscellaneous Examinations

Code	Description	Amount	Ans Units	Assist Units
X151	Cordotomy, percutaneous
	- Technical Fee	$48.40	N/A	N/A
	- Professional Fee	$34.85	N/A	N/A
X163	Dacrocystogram
	- Technical Fee	$29.60	N/A	N/A
	- Professional Fee	$11.60	N/A	N/A
X164	Discogram(s) - one or more levels
	- Technical Fee	$28.95	N/A	N/A
	- Professional Fee	$23.00	N/A	N/A
X167	Fistula or sinus
	- Technical Fee	$21.50	N/A	N/A
	- Professional Fee	$11.45	N/A	N/A
X169	Laminogram, planigram, tomogram
	- Technical Fee	$39.90	N/A	N/A
	- Professional Fee	$11.35	N/A	N/A
X170	Laryngogram
	- Technical Fee	$28.95	N/A	N/A
	- Professional Fee	$23.00	N/A	N/A
X171	Lymphangiogram
	- Technical Fee	$49.00	N/A	N/A
	- Professional Fee	$23.05	N/A	N/A
X192	Mammary ductography
	- Technical Fee	$25.05	N/A	N/A
	- Professional Fee	$10.65	N/A	N/A
X184	Mammogram - Signs or Symptoms - Dedicated equipment - unilateral
	- Technical Fee	$28.05	N/A	N/A
	- Professional Fee	$16.90	N/A	N/A
X185	Mammogram - Signs or Symptoms - Dedicated equipment - bilateral
	- Technical Fee	$37.15	N/A	N/A
	- Professional Fee	$27.00	N/A	N/A
X172	Mammogram - No Signs or Symptoms - Dedicated Equipment - unilateral
	- Technical Fee	$28.05	N/A	N/A
	- Professional Fee	$16.90	N/A	N/A
X178	Mammogram - No Signs or Symptoms - Dedicated Equipment - bilateral
	- Technical Fee	$37.15	N/A	N/A
	- Professional Fee	$27.00	N/A	N/A
X194	Additional coned views with or without magnification (limit of two per breast) per film
	- Technical Fee	$5.95	N/A	N/A
	- Professional Fee	$5.20	N/A	N/A
X201	Breast biopsy specimen x-ray, per specimen
	- Technical Fee	$5.95	N/A	N/A
	- Professional Fee	$5.20	N/A	N/A
X150	Mechanical evaluation of knee
	- Technical Fee	$25.45	N/A	N/A
	- Professional Fee	$15.85	N/A	N/A
X193	Microradioscopy of the hands
	- Technical Fee	$14.50	N/A	N/A
	- Professional Fee	$11.60	N/A	N/A
X173	Myelogram - spine and/or posterior fossa
	- Technical Fee	$34.95	N/A	N/A
	- Professional Fee	$27.30	N/A	N/A
X190	Pantomography
	- Technical Fee	$17.75	N/A	N/A
	- Professional Fee	$6.90	N/A	N/A
X154	Penis
	- Technical Fee	$15.95	N/A	N/A
	- Professional Fee	$4.70	N/A	N/A
X165	Photographic subtraction
	- Professional Fee	$11.35	N/A	N/A
X176	Sialogram
	- Technical Fee	$29.80	N/A	N/A
	- Professional Fee	$11.35	N/A	N/A
X177	Skin thickness measurement
	- Technical Fee	$15.60	N/A	N/A
	- Professional Fee	$9.20	N/A	N/A
X183	Ventriculogram
	- Technical Fee	$48.40	N/A	N/A
	- Professional Fee	$34.70	N/A	N/A
X166	Examination using portable machine “in home” add to first examination only	$0.00	N/A	N/A

Computed Tomography (Ct)

Code	Description	Amount	Ans Units	Assist Units
X400	Head - without IV contrast
	- Professional Fee	$43.25	N/A	N/A
X401	Head - with IV contrast
	- Professional Fee	$64.95	N/A	N/A
X188	Head - with and without IV contrast
	E874 - Head with CT perfusion study, to X188, X400, X401, X402, X405, or X408 … add	$0.00	N/A	N/A
	- Professional Fee	$75.85	N/A	N/A
X402	Complex head - without IV contrast
	- Professional Fee	$64.95	N/A	N/A
X405	Complex head - with IV contrast
	- Professional Fee	$75.85	N/A	N/A
X408	Complex head - with and without IV contrast
	- Professional Fee	$86.60	N/A	N/A
X403	Neck - without IV contrast
	- Professional Fee	$86.60	N/A	N/A
X404	Neck - with IV contrast
	- Professional Fee	$97.50	N/A	N/A
X124	Neck - with and without IV contrast
	- Professional Fee	$108.30	N/A	N/A
X406	Thorax - without IV contrast
	- Professional Fee	$64.95	N/A	N/A
X407	Thorax - with IV contrast
	- Professional Fee	$75.85	N/A	N/A
X125	Thorax - with and without IV contrast
	- Professional Fee	$86.60	N/A	N/A
X235	Cardio-thoracic
	- Professional Fee	$147.50	N/A	N/A
X409	Abdomen - without IV contrast
	- Professional Fee	$86.60	N/A	N/A
X410	Abdomen - with IV contrast
	- Professional Fee	$97.50	N/A	N/A
X126	Abdomen - with and without IV contrast
	- Professional Fee	$108.30	N/A	N/A
X231	Pelvis - without IV contrast
	- Professional Fee	$86.60	N/A	N/A
X232	Pelvis - with IV contrast
	- Professional Fee	$97.50	N/A	N/A
X233	Pelvis - with and without IV contrast
	- Professional Fee	$108.30	N/A	N/A
X234	CT colonography
	- Professional Fee	$235.30	N/A	N/A
X412	Extremities (one or more) - without IV contrast
	- Professional Fee	$43.25	N/A	N/A
X413	Extremities (one or more) - with IV contrast
	- Professional Fee	$64.95	N/A	N/A
X127	Extremities (one or more) - with and without IV contrast
	- Professional Fee	$75.85	N/A	N/A
X415	Spine(s) -without IV contrast
	- Professional Fee	$86.60	N/A	N/A
X416	Spine(s) - with IV contrast
	- Professional Fee	$97.50	N/A	N/A
X128	Spine(s) - with and without IV contrast
	- Professional Fee	$108.30	N/A	N/A
X168	CT guidance of biopsy
	- Professional Fee	$42.50	N/A	N/A
X417	Three dimensional CT acquisition sequencing, including post-processing (minimum of 60 slices; maximum 1 scan per patient per day).
	- Professional Fee	$32.70	N/A	N/A

Bone Mineral Density (Bmd) Measurement

Code	Description	Amount	Ans Units	Assist Units
X145	Baseline test - one site
	- Technical Fee	$42.85	N/A	N/A
	- Professional Fee	$40.15	N/A	N/A
X146	Baseline test - two or more sites
	- Technical Fee	$55.20	N/A	N/A
	- Professional Fee	$48.00	N/A	N/A
X152	Second test - low risk patient - one site
	- Technical Fee	$42.85	N/A	N/A
	- Professional Fee	$40.15	N/A	N/A
X153	Second test - low risk patient - two or more sites
	- Technical Fee	$55.20	N/A	N/A
	- Professional Fee	$48.00	N/A	N/A
X142	Subsequent test - low risk patient - one site
	- Technical Fee	$42.85	N/A	N/A
	- Professional Fee	$40.15	N/A	N/A
X148	Subsequent test - low risk patient - two or more sites
	- Technical Fee	$55.20	N/A	N/A
	- Professional Fee	$48.00	N/A	N/A
X149	Subsequent test - high risk patient - one site
	- Technical Fee	$42.85	N/A	N/A
	- Professional Fee	$40.15	N/A	N/A
X155	Subsequent test - high risk patient - two or more sites
	- Technical Fee	$55.20	N/A	N/A
	- Professional Fee	$48.00	N/A	N/A

Special Examinations

Code	Description	Amount	Ans Units	Assist Units
X179	Abdominal, thoracic, cervical or cranial angiogram by catheterization - Using single films - non-selective
	- Technical Fee	$29.60	N/A	N/A
	- Professional Fee	$15.85	N/A	N/A
X180	Abdominal, thoracic, cervical or cranial angiogram by catheterization - selective (per vessel, to a maximum of 4)
	- Technical Fee	$38.95	N/A	N/A
	- Professional Fee	$31.35	N/A	N/A
X181	Abdominal, thoracic, cervical or cranial angiogram by catheterization - Using film changer, cine or multiformat camera - non-selective
	- Technical Fee	$59.65	N/A	N/A
	- Professional Fee	$30.90	N/A	N/A
X182	Abdominal, thoracic, cervical or cranial angiogram by catheterization - Using film changer, cine or multiformat camera - selective (per vessel, to a maximum of 4)
	- Technical Fee	$79.30	N/A	N/A
	- Professional Fee	$37.45	N/A	N/A
X140	Abdominal, thoracic, cervical or cranial angiogram by catheterization - Using film changer, cine or multiformat camera - selective (5 or more vessels)
	- Technical Fee	$317.35	N/A	N/A
	- Professional Fee	$185.60	N/A	N/A
X160	Carotid angiogram by direct puncture - unilateral
	- Technical Fee	$48.90	N/A	N/A
	- Professional Fee	$34.00	N/A	N/A
X161	Carotid angiogram by direct puncture - bilateral
	- Technical Fee	$78.60	N/A	N/A
	- Professional Fee	$69.65	N/A	N/A
X174	Peripheral angiogram - unilateral
	- Technical Fee	$29.80	N/A	N/A
	- Professional Fee	$15.50	N/A	N/A
X175	Peripheral angiogram - bilateral
	- Technical Fee	$39.35	N/A	N/A
	- Professional Fee	$30.90	N/A	N/A
X198	Splenoportogram
	- Technical Fee	$59.10	N/A	N/A
	- Professional Fee	$22.60	N/A	N/A
X199	Translumbar aortogram
	- Technical Fee	$59.10	N/A	N/A
	- Professional Fee	$22.60	N/A	N/A
X132	Vertebral angiogram - direct puncture or retrograde brachial injection - unilateral
	- Technical Fee	$48.90	N/A	N/A
	- Professional Fee	$34.00	N/A	N/A
X133	Vertebral angiogram - direct puncture or retrograde brachial injection - bilateral
	- Technical Fee	$79.90	N/A	N/A
	- Professional Fee	$51.05	N/A	N/A
X156	Arthrogram, tenogram or bursogram
	- Technical Fee	$26.25	N/A	N/A
	- Professional Fee	$27.50	N/A	N/A
X200	Arthrogram, tenogram or bursogram - with fluoroscopy and complete positioning throughout by physician
	- Technical Fee	$36.70	N/A	N/A
	- Professional Fee	$45.55	N/A	N/A
X158	Bronchogram - unilateral
	- Technical Fee	$28.95	N/A	N/A
	- Professional Fee	$23.00	N/A	N/A
X159	Bronchogram - bilateral
	- Technical Fee	$38.40	N/A	N/A
	- Professional Fee	$34.60	N/A	N/A
X162	Cerebral stereotaxis
	- Technical Fee	$59.20	N/A	N/A
	- Professional Fee	$23.10	N/A	N/A
X122	Cholangiogram, percutaneous trans-hepatic
	- Technical Fee	$29.50	N/A	N/A
	- Professional Fee	$23.15	N/A	N/A
X121	Stereotactic core breast biopsy
	- Professional Fee	$83.15	N/A	N/A

Fluoroscopy By Physician With Or Without Spot Films

Code	Description	Amount	Ans Units	Assist Units
X195	Chest
	- Technical Fee	$9.25	N/A	N/A
	- Professional Fee	$14.20	N/A	N/A
X196	Skeleton
	- Technical Fee	$9.25	N/A	N/A
	- Professional Fee	$14.20	N/A	N/A
X197	Abdomen
	- Technical Fee	$9.25	N/A	N/A
	- Professional Fee	$14.20	N/A	N/A
X189	Fluoroscopic control of clinical procedures done by another physician per 1/4 hour
	- Technical Fee	$7.30	N/A	N/A
	- Professional Fee	$23.75	N/A	N/A

Obstetrics And Gynaecology

Code	Description	Amount	Ans Units	Assist Units
X147	Hysterosalpingogram
	- Technical Fee	$29.80	N/A	N/A
	- Professional Fee	$11.35	N/A	N/A

Genitourinary Tract

Code	Description	Amount	Ans Units	Assist Units
X129	Retrograde pyelogram, unilateral or bilateral
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$9.00	N/A	N/A
X130	Intravenous pyelogram including preliminary film
	- Technical Fee	$49.65	N/A	N/A
	- Professional Fee	$22.75	N/A	N/A
X137	Cystogram (catheter)
	- Technical Fee	$23.85	N/A	N/A
	- Professional Fee	$8.40	N/A	N/A
X135	Cystourethrogram, stress or voiding (catheter)
	- Technical Fee	$27.50	N/A	N/A
	- Professional Fee	$13.80	N/A	N/A
X131	Cystourethrogram (non-catheter)
	- Technical Fee	$5.75	N/A	N/A
	- Professional Fee	$4.75	N/A	N/A
X191	Intestinal conduit examination or nephrostogram
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$9.00	N/A	N/A
X138	Percutaneous antegrade pyelogram
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$9.00	N/A	N/A
X139	Percutaneous nephrostogram
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$11.10	N/A	N/A
X134	Retrograde urethrogram
	- Technical Fee	$17.95	N/A	N/A
	- Professional Fee	$6.80	N/A	N/A
X136	Vasogram
	- Technical Fee	$17.95	N/A	N/A
	- Professional Fee	$6.80	N/A	N/A
X141	Cavernosography
	- Technical Fee	$20.65	N/A	N/A
	- Professional Fee	$8.30	N/A	N/A

Gastrointestinal Tract

Code	Description	Amount	Ans Units	Assist Units
X105	Palatopharyngeal analysis - cine or videotape
	- Technical Fee	$29.50	N/A	N/A
	- Professional Fee	$36.90	N/A	N/A
X106	Pharynx and oesophagus - cine or videotape
	- Technical Fee	$29.50	N/A	N/A
	- Professional Fee	$36.90	N/A	N/A
X107	Oesophagus when X103, X104, X108 or X109 not claimed
	- Technical Fee	$26.70	N/A	N/A
	- Professional Fee	$21.40	N/A	N/A
X108	Oesophagus, stomach and duodenum - including survey film, if taken
	- Technical Fee	$46.30	N/A	N/A
	- Professional Fee	$38.15	N/A	N/A
X104	Oesophagus, stomach and duodenum - double contrast, including survey film, if taken
	- Technical Fee	$48.50	N/A	N/A
	- Professional Fee	$46.40	N/A	N/A
X103	Oesophagus, stomach and duodenum - double contrast, including survey film, if taken, and small bowel
	- Technical Fee	$60.95	N/A	N/A
	- Professional Fee	$58.40	N/A	N/A
X110	Hypotonic duodenogram
	- Technical Fee	$39.35	N/A	N/A
	- Professional Fee	$32.95	N/A	N/A
X109	Oesophagus, stomach and small bowel
	- Technical Fee	$59.10	N/A	N/A
	- Professional Fee	$49.80	N/A	N/A
X111	Small bowel only - when only examination performed during patient’s visit
	- Technical Fee	$26.40	N/A	N/A
	- Professional Fee	$21.80	N/A	N/A
X112	Colon - barium enema including survey film, if taken
	- Technical Fee	$48.40	N/A	N/A
	- Professional Fee	$29.40	N/A	N/A
X113	Colon - air contrast, primary or secondary, including survey films, if taken
	- Technical Fee	$61.30	N/A	N/A
	- Professional Fee	$49.80	N/A	N/A
X114	Gallbladder - one or multiple day examinations
	- Technical Fee	$29.95	N/A	N/A
	- Professional Fee	$11.60	N/A	N/A
X120	Gallbladder - one or multiple day examinations with preliminary plain film
	- Technical Fee	$39.80	N/A	N/A
	- Professional Fee	$11.60	N/A	N/A
X116	T-tube cholangiogram
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$9.90	N/A	N/A
X117	Operative cholangiogram
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$11.10	N/A	N/A
X123	Operative pancreatogram or ERCP
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$9.00	N/A	N/A

Chest And Abdomen

Code	Description	Amount	Ans Units	Assist Units
X090	Chest - single view
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X091	Chest - two views
	- Technical Fee	$21.90	N/A	N/A
	- Professional Fee	$10.75	N/A	N/A
X092	Chest - three or more views
	- Technical Fee	$28.15	N/A	N/A
	- Professional Fee	$12.45	N/A	N/A
X039	Ribs - two or more views
	- Technical Fee	$17.95	N/A	N/A
	- Professional Fee	$7.85	N/A	N/A
X040	Sternum - two or more views
	- Technical Fee	$17.95	N/A	N/A
	- Professional Fee	$7.85	N/A	N/A
X096	Thoracic inlet - two or more views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X100	Abdomen - single view
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X101	Abdomen - two or more views
	- Technical Fee	$22.80	N/A	N/A
	- Professional Fee	$9.20	N/A	N/A

Skeletal Surveys

Code	Description	Amount	Ans Units	Assist Units
X057	Skeletal survey for bone age - single film
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X058	Skeletal survey for bone age - two or more films or views
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$10.65	N/A	N/A
X080	Other survey studies - e.g. rheumatoid, metabolic or metastatic - single view
	- Technical Fee	$7.45	N/A	N/A
	- Professional Fee	$3.30	N/A	N/A
X081	Other survey studies - e.g. rheumatoid, metabolic or metastatic - each additional film or view
	- Technical Fee	$7.45	N/A	N/A
	- Professional Fee	$3.30	N/A	N/A

Lower Extremeties

Code	Description	Amount	Ans Units	Assist Units
X060	Hip (unilateral) - two or more views
	- Technical Fee	$23.75	N/A	N/A
	- Professional Fee	$7.65	N/A	N/A
X063	Femur including one joint - two views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X223	Femur including one joint - three or more views
	- Technical Fee	$22.20	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X065	Knee including patella - two views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X224	Knee including patella - three or four views
	- Technical Fee	$22.90	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X225	Knee including patella - five or more views
	- Technical Fee	$30.85	N/A	N/A
	- Professional Fee	$11.65	N/A	N/A
X066	Tibia and fibula including one joint - two views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X226	Tibia and fibula including one joint - three or more views
	- Technical Fee	$22.90	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X067	Ankle - two or three views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X227	Ankle - four or more views
	- Technical Fee	$22.90	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X068	Calcaneus - two views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X228	Calcaneus - three or more views
	- Technical Fee	$22.90	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X069	Foot - two or three views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X229	Foot - four or more views
	- Technical Fee	$22.90	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X072	Toe - two views
	- Technical Fee	$11.50	N/A	N/A
	- Professional Fee	$4.70	N/A	N/A
X230	Toe - three or more views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X064	Leg length studies (orthoroentgenogram)
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$10.35	N/A	N/A

Upper Extremeties

Code	Description	Amount	Ans Units	Assist Units
X045	Clavicle - two views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X209	Clavicle - three or more views
	- Technical Fee	$22.90	N/A	N/A
	- Professional Fee	$8.90	N/A	N/A
X046	Acromioclavicular joints (bilateral) with or without weighted distraction - two views
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$10.35	N/A	N/A
X210	Acromioclavicular joints (bilateral) with or without weighted distraction - three or more views
	- Technical Fee	$29.60	N/A	N/A
	- Professional Fee	$13.05	N/A	N/A
X047	Sternoclavicular joints (bilateral) - two or three views
	- Technical Fee	$17.95	N/A	N/A
	- Professional Fee	$7.95	N/A	N/A
X211	Sternoclavicular joints (bilateral) - four or more views
	- Technical Fee	$25.60	N/A	N/A
	- Professional Fee	$10.90	N/A	N/A
X048	Shoulder - two views
	- Technical Fee	$17.95	N/A	N/A
	- Professional Fee	$7.95	N/A	N/A
X212	Shoulder - three or more views
	- Technical Fee	$25.60	N/A	N/A
	- Professional Fee	$10.65	N/A	N/A
X049	Scapula - two views
	- Technical Fee	$17.95	N/A	N/A
	- Professional Fee	$7.95	N/A	N/A
X213	Scapula - three or more views
	- Technical Fee	$25.80	N/A	N/A
	- Professional Fee	$10.65	N/A	N/A
X050	Humerus including one joint - two views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X214	Humerus including one joint - three or more views
	- Technical Fee	$22.75	N/A	N/A
	- Professional Fee	$9.30	N/A	N/A
X051	Elbow - two views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X215	Elbow - three or four views
	- Technical Fee	$22.90	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X216	Elbow - five or more views
	- Technical Fee	$30.85	N/A	N/A
	- Professional Fee	$11.65	N/A	N/A
X052	Forearm including one joint - two views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X217	Forearm including one joint - three or more views
	- Technical Fee	$22.90	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X053	Wrist - two or three views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X218	Wrist - four or more views
	- Technical Fee	$22.90	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X054	Hand - two or three views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X219	Hand - four or more views
	- Technical Fee	$22.90	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X055	Wrist and hand - two or three views
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$13.05	N/A	N/A
X220	Wrist and hand - four or more views
	- Technical Fee	$27.65	N/A	N/A
	- Professional Fee	$15.70	N/A	N/A
X056	Finger or thumb - two views
	- Technical Fee	$11.50	N/A	N/A
	- Professional Fee	$4.70	N/A	N/A
X221	Finger or thumb - three or more views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A

Spine And Pelvis

Code	Description	Amount	Ans Units	Assist Units
X025	Cervical spine - two or three views
	- Technical Fee	$25.90	N/A	N/A
	- Professional Fee	$7.95	N/A	N/A
X202	Cervical spine - four or five views
	- Technical Fee	$33.40	N/A	N/A
	- Professional Fee	$10.75	N/A	N/A
X203	Cervical spine - six or more views
	- Technical Fee	$40.35	N/A	N/A
	- Professional Fee	$13.25	N/A	N/A
X027	Thoracic spine - two views
	- Technical Fee	$23.65	N/A	N/A
	- Professional Fee	$7.95	N/A	N/A
X204	Thoracic spine - three or more
	- Technical Fee	$29.90	N/A	N/A
	- Professional Fee	$10.65	N/A	N/A
X028	Lumbar or lumbosacral spine - two or three views
	- Technical Fee	$25.90	N/A	N/A
	- Professional Fee	$7.95	N/A	N/A
X205	Lumbar or lumbosacral spine - four or five views
	- Technical Fee	$33.40	N/A	N/A
	- Professional Fee	$10.75	N/A	N/A
X206	Lumbar or lumbosacral spine - six or more views
	- Technical Fee	$40.35	N/A	N/A
	- Professional Fee	$13.35	N/A	N/A
X032	Entire spine (scoliosis series) - four views
	- Technical Fee	$53.55	N/A	N/A
	- Professional Fee	$20.75	N/A	N/A
X033	Orthoroentgenogram (3 foot film) - single view
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$10.15	N/A	N/A
X031	Orthoroentgenogram (3 foot film) - two or more views
	- Technical Fee	$29.70	N/A	N/A
	- Professional Fee	$13.35	N/A	N/A
X034	Sacrum and/or coccyx - two views
	- Technical Fee	$23.95	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X207	Sacrum and/or coccyx - three or more views
	- Technical Fee	$31.05	N/A	N/A
	- Professional Fee	$10.65	N/A	N/A
X035	Sacro-iliac joints - two or three views
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$10.35	N/A	N/A
X208	Sacro-iliac joints - four or more views
	- Technical Fee	$28.95	N/A	N/A
	- Professional Fee	$13.05	N/A	N/A
X036	Pelvis and/or hip(s) - one view
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X037	Pelvis and/or hip(s) - two views (e.g. AP and frog view, both hips, or AP both hips plus lateral one hip)
	- Technical Fee	$27.75	N/A	N/A
	- Professional Fee	$9.20	N/A	N/A
X038	Pelvis and/or hip(s) - three or more views (e.g. pelvis and sacro-iliac joints, or AP both hips plus lateral each hip)
	- Technical Fee	$31.90	N/A	N/A
	- Professional Fee	$10.35	N/A	N/A

Head And Neck

Code	Description	Amount	Ans Units	Assist Units
X001	Skull - four views
	- Technical Fee	$29.90	N/A	N/A
	- Professional Fee	$13.25	N/A	N/A
X009	Skull - five or more views
	- Technical Fee	$37.25	N/A	N/A
	- Professional Fee	$16.40	N/A	N/A
X003	Sella turcica (when skull not examined)
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X004	Facial bones - three views
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$10.30	N/A	N/A
X005	Nose - two views
	- Technical Fee	$14.90	N/A	N/A
	- Professional Fee	$6.40	N/A	N/A
X006	Mandible - three views (unilateral or bilateral)
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$10.35	N/A	N/A
X012	Mandible - four or more views
	- Technical Fee	$29.90	N/A	N/A
	- Professional Fee	$13.25	N/A	N/A
X007	Temporomandibular joints - four views including open and closed mouth views
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$10.35	N/A	N/A
X008	Sinuses - three views
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$10.35	N/A	N/A
X010	Mastoids - bilateral - six views
	- Technical Fee	$28.65	N/A	N/A
	- Professional Fee	$14.25	N/A	N/A
X011	Mastoids - bilateral - Internal auditory meati (when skull not examined)
	- Technical Fee	$21.70	N/A	N/A
	- Professional Fee	$10.35	N/A	N/A
X016	Eye, for foreign body
	- Technical Fee	$14.85	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X017	Eye, for localization, additional
	- Technical Fee	$15.30	N/A	N/A
	- Professional Fee	$20.40	N/A	N/A
X018	Optic foramina
	- Technical Fee	$16.85	N/A	N/A
	- Professional Fee	$9.05	N/A	N/A
X019	Salivary gland region
	- Technical Fee	$13.75	N/A	N/A
	- Professional Fee	$7.95	N/A	N/A
X020	Neck for soft tissues - two views
	- Technical Fee	$13.75	N/A	N/A
	- Professional Fee	$7.95	N/A	N/A

Non Emergency Hospital In Patient Services

Code	Description	Amount	Ans Units	Assist Units
C335	Consultation subject to the same conditions as A335	$50.00	N/A	N/A
C365	Special interventional radiological consultation subject to the same conditions as A365	$223.20	N/A	N/A
C330	Radiology second opinion of CT study, per study subject to the same conditions as A330	$89.50	N/A	N/A
C332	Radiology second opinion of MRI study, per study subject to the same conditions as A332	$199.70	N/A	N/A

Miscellaneous Procedures

Code	Description	Amount	Ans Units	Assist Units
J001	Arthrogram, tenogram or bursogram	$29.55	7	N/A
J024	Bronchial brushing - unilateral	$89.90	6	N/A
J044	Bronchial brushing - bilateral	$135.00	6	N/A
J002	Bronchogram - unilateral	$27.00	6	N/A
J043	Bronchogram - bilateral	$40.65	6	N/A
J003	Bronchogram with intra-tracheal catheter - unilateral	$68.00	6	N/A
J042	Bronchogram with intra-tracheal catheter - bilateral	$82.20	6	N/A
J050	Carotid or vertebral artery occlusion by detachable balloon - percutaneous	$297.30	N/A	N/A
J053	Cavernosography	$45.35	N/A	N/A
J005	Dacrocystogram	$45.40	6	N/A
J006	Discogram - one disc	$105.30	7	N/A
J030	Discogram - each additional disc … add	$54.05	N/A	N/A
J049	Embolization of spinal arteriovenous malformation - percutaneous	$437.30	6	N/A
J036	Fistula or sinus injection	$26.95	N/A	N/A
J068	Hydrostatic/pneumatic reduction of intussusception	$44.25	7	N/A
J008	Hysterosalpingogram	$56.70	6	N/A
J004	Intramammary needling for localization under mammographic control	$70.35	N/A	N/A
J009	Laryngogram	$33.50	N/A	N/A
J010	Lymphangiogram - per side	$105.30	N/A	N/A
J037	Mammary ductography	$70.35	N/A	N/A
J011	Myelogram	$93.40	6	N/A
J038	Myelogram - with supine views requiring removal and re-introduction of spinal needle … add	$21.75	N/A	N/A
J020	Myelogram - with posterior fossa views … add	$23.85	N/A	N/A
J012	Nephrotomogram	$0.00	6	N/A
J060	Nephrostogram	$29.55	N/A	N/A
J045	Percutaneous antegrade pyelogram	$122.10	6	N/A
J055	Percutaneous gastrostomy	$223.75	N/A	N/A
J061	Percutaneous cecostomy	$223.75	N/A	N/A
J062	Percutaneous cholecystostomy	$223.75	N/A	N/A
J063	Percutaneous jejunostomy	$259.55	N/A	N/A
J064	Exchange of drainage tubes, including supervision, imaging and hard copy film interpretation if any	$72.65	N/A	N/A
J046	Percutaneous nephrostomy	$223.75	6	N/A
J041	Percutaneous removal of intravascular and intraureteric foreign bodies	$295.25	0	N/A
J065	Dilation of non-vascular structures	$20.50	6	N/A
J059	Non-vascular stenting	$101.55	N/A	N/A
J069	Percutaneous radiofrequency ablation using CT or ultrasound guidance	$515.70	N/A	N/A
J051	Percutaneous spinal cord puncture for syringogram	$94.60	6	N/A
J013	Percutaneous trans-hepatic cholangiogram	$105.30	6	N/A
J057	Transjugular intrahepatic portosystemic shunt (TIPS)	$787.35	7	N/A
J052	Positive contrast cisternogram	$99.90	6	N/A
Z597	Intracavitary/intratumoural injections	$90.10	7	N/A
J039	Renal cyst puncture	$121.95	6	N/A
J018	Sialogram	$45.40	6	N/A
J007	Tomogram	$0.00	7	N/A
J028	Urethrogram and/or urethrocystogram and/or or intestinal conduit examination, cystogram	$29.55	N/A	N/A
J029	Vasogram	$59.95	6	N/A