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