The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 72195. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export
- Full state Medicaid dental network lists
- Email alerts when a state changes its rates
$29/mo after the trial. Cancel anytime.
Publishing states
47
Median % of Medicare
99.5%
Rate range
$116.82 - $529.87
72195 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $363.92 | 160% | -- | 2026 |
| Alabama | $397.48 | 174.8% | -- | 2026 |
| Arkansas | $488.67 | 214.8% | -- | 2026 |
| Arizona | $253.66 | 111.5% | -- | 2022 |
| California | $226.34 | 99.5% | -- | 2026 |
| Colorado | $261.19 | 114.8% | Required | 2026 |
| Connecticut | $288.02 | 126.6% | Required | 2015 |
| District of Columbia | $209.50 | 92.1% | Not required | 2026 |
| Delaware | $221.09 | 97.2% | -- | 2026 |
| Georgia | $487.31 | 214.2% | -- | 2026 |
| Hawaii | $156.73 | 68.9% | -- | 2025 |
| Iowa | $346.15 | 152.2% | -- | 2024 |
| Idaho | $182.92 | 80.4% | Not required | 2026 |
| Illinois | $211.01 | 92.8% | -- | 2024 |
| Indiana | $215.74 | 94.9% | -- | 2025 |
| Kansas | $223.59 | 98.3% | -- | 2024 |
| Kentucky | $357.63 | 157.2% | Required | 2026 |
| Louisiana | $346.75 | 152.5% | -- | 2026 |
| Massachusetts | $313.73 | 137.9% | -- | 2025 |
| Maine | $153.60 | 67.5% | -- | 2026 |
| Michigan | $145.05 | 63.8% | -- | 2026 |
| Minnesota | $177.53 | 78.1% | -- | 2026 |
| Missouri | $244.56 | 107.5% | Required | 2022 |
| Mississippi | $181.86 | 80% | -- | 2026 |
| Montana | $315.05 | 138.5% | -- | 2026 |
| North Carolina | $435.25 | 191.4% | -- | 2025 |
| North Dakota | $253.83 | 111.6% | Not required | 2026 |
| Nebraska | $529.87 | 233% | -- | 2026 |
| New Hampshire | $213.50 | 93.9% | Required | 2026 |
| New Jersey | $116.82 | 51.4% | Not required | 2026 |
| New Mexico | $319.28 | 140.4% | -- | 2023 |
| Nevada | $420.26 | 184.8% | -- | 2024 |
| New York | $334.10 | 146.9% | -- | 2026 |
| Ohio | $226.46 | 99.6% | -- | 2024 |
| Oklahoma | $194.38 | 85.5% | -- | 2026 |
| Oregon | $184.80* | 81.2% | -- | 2026 |
| Pennsylvania | $328.67 | 144.5% | -- | 2010 |
| Rhode Island | $511.51 | 224.9% | -- | 2026 |
| South Carolina | $167.88 | 73.8% | -- | 2024 |
| Texas | $188.98* | 83.1% | -- | 2025 |
| Utah | $211.99* | 93.2% | Required | 2026 |
| Virginia | $197.05 | 86.6% | -- | 2026 |
| Vermont | $191.77 | 84.3% | -- | 2026 |
| Washington | $141.03 | 62% | -- | 2026 |
| Wisconsin | $409.04 | 179.8% | -- | 2010 |
| West Virginia | $149.57 | 65.8% | -- | 2026 |
| Wyoming | $201.37 | 88.5% | -- | 2026 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related lab & imaging codes
- 70110 - Jaw (mandible) X-ray, 4 or more views
- 70140 - Facial bone X-ray, under 3 views
- 70160 - Nasal bone X-ray
- 70220 - Sinus X-ray, 3 or more views
- 70360 - Neck soft tissue X-ray
- 70450 - CT scan of the head without contrast
- 70480 - CT scan of the eye socket or inner ear without contrast
- 70486 - CT scan of the face and sinuses without contrast
Frequently asked questions
How much does Medicaid pay for 72195?
47 state Medicaid programs publish a fee-for-service rate for 72195 (mRI of the pelvis without contrast), ranging from $116.82 in New Jersey to $529.87 in Nebraska, with a median of 99.5% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 72195?
Nebraska publishes the highest Medicaid rate for 72195 at $529.87 (233% of the national Medicare amount). New Jersey publishes the lowest at $116.82.
Does 72195 require prior authorization under Medicaid?
6 of the 47 publishing states flag 72195 as requiring prior authorization (always or conditionally) on their fee schedules. States without a flag publish no PA indicator for this code - that means "not published", not "no PA required".