| Code | Description | States | Median rate |
|---|---|---|---|
| 72020 | Spine X-ray, single view | 48 | $20.05 |
| 72040 | Neck (cervical) spine X-ray, 2-3 views | 48 | $31.72 |
| 72050 | Neck (cervical) spine X-ray, 4-5 views | 48 | $44.24 |
| 72052 | Neck (cervical) spine X-ray, 6 or more views | 48 | $50.65 |
| 72070 | Mid-back (thoracic) spine X-ray, 2 views | 48 | $28.13 |
| 72072 | Mid-back (thoracic) spine X-ray, 3 views | 48 | $31.33 |
| 72074 | Mid-back (thoracic) spine X-ray, 4 or more views | 48 | $35.57 |
| 72080 | Thoracolumbar junction spine X-ray, 2 views | 48 | $29.24 |
| 72081 | Whole spine X-ray (scoliosis), one view | 48 | $34.34 |
| 72082 | Whole spine X-ray (scoliosis), 2 or 3 views | 48 | $56.20 |
| 72083 | Whole spine X-ray (scoliosis), 4 or 5 views | 48 | $62.58 |
| 72084 | Whole spine X-ray (scoliosis), 6 or more views | 48 | $77.70 |
| 72100 | Lower back (lumbar) spine X-ray, 2-3 views | 48 | $32.63 |
| 72110 | Lower back (lumbar) spine X-ray, 4 or more views | 48 | $43.61 |
| 72114 | Lower (lumbar) spine X-ray with bending views, 6 or more | 48 | $52.13 |
| 72120 | Lower back X-ray, bending views only | 48 | $35.48 |
| 72125 | CT scan of the neck (cervical) spine without contrast | 48 | $124.99 |
| 72126 | CT scan of the neck spine with contrast | 48 | $156.55 |
| 72127 | CT scan of the neck spine, without then with contrast | 48 | $192.38 |
| 72128 | CT scan of the mid-back spine without contrast | 48 | $124.68 |
| 72129 | CT scan of the mid-back spine with contrast | 48 | $157.72 |
| 72130 | CT scan of the mid-back spine, without then with contrast | 48 | $193.14 |
| 72131 | CT scan of the lower (lumbar) spine without contrast | 48 | $124.34 |
| 72132 | CT scan of the lower back spine with contrast | 48 | $156.85 |
| 72133 | CT scan of the lower back spine, without then with contrast | 48 | $192.07 |
| 72141 | MRI of the neck (cervical) spine without contrast | 48 | $187.18 |
| 72142 | MRI of the neck spine with contrast | 48 | $271.04 |
| 72146 | MRI of the mid-back spine without contrast | 48 | $186.93 |
| 72147 | MRI of the mid-back spine with contrast | 48 | $268.32 |
| 72148 | MRI of the lower (lumbar) spine without contrast | 48 | $187.42 |
| 72149 | MRI of the lower back spine with contrast | 48 | $266.46 |
| 72156 | MRI of the neck (cervical) spine without then with contrast | 48 | $315.13 |
| 72157 | MRI of the mid-back spine, without then with contrast | 48 | $315.61 |
| 72158 | MRI of the lower back spine, without then with contrast | 48 | $314.34 |
| 72159 | MR angiogram of the spinal canal | 45 | $324.56 |
| 72170 | Pelvis X-ray, 1-2 views | 48 | $22.64 |
| 72190 | Pelvis X-ray, 3 or more views | 48 | $34.61 |
| 72191 | CT angiogram of the pelvis | 48 | $273.77 |
| 72192 | CT scan of the pelvis without contrast | 48 | $123.22 |
| 72193 | CT scan of the pelvis with contrast | 48 | $204.45 |
| 72194 | CT scan of the pelvis, without then with contrast | 48 | $231.98 |
| 72195 | MRI of the pelvis without contrast | 48 | $226.40 |
| 72196 | MRI of the pelvis with contrast | 48 | $265.51 |
| 72197 | MRI of the pelvis, without then with contrast | 48 | $333.46 |
| 72198 | MR angiogram of the pelvis | 48 | $328.83 |
| 72200 | Sacroiliac joint X-ray, up to 2 views | 48 | $26.65 |
| 72202 | Sacroiliac joint X-ray, 3 or more views | 48 | $31.00 |
| 72220 | Tailbone (sacrum and coccyx) X-ray | 48 | $25.91 |
| 72240 | Neck spine myelogram, reading | 48 | $96.72 |
| 72255 | Mid-back spine myelogram, reading | 48 | $94.50 |
| 72265 | Lower back spine myelogram, reading | 48 | $95.03 |
| 72270 | Myelogram of two or more spine regions, reading | 48 | $129.28 |
| 72285 | Neck or mid-back disc dye study (discogram), reading | 48 | $122.21 |
| 72295 | Lower back disc dye study (discogram), reading | 48 | $102.07 |
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. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.