| Code | Description | States | Median rate |
|---|---|---|---|
| 73000 | Collarbone X-ray | 48 | $26.48 |
| 73010 | Shoulder blade (scapula) X-ray | 48 | $21.43 |
| 73020 | Shoulder X-ray, single view | 48 | $18.81 |
| 73030 | Shoulder X-ray, 2 or more views | 48 | $28.38 |
| 73040 | Shoulder X-ray with joint dye (arthrogram), reading | 48 | $105.49 |
| 73050 | Both collarbone (AC) joints X-ray | 48 | $25.92 |
| 73060 | Upper arm (humerus) X-ray, 2 or more views | 48 | $26.00 |
| 73070 | Elbow X-ray, 2 views | 48 | $23.82 |
| 73080 | Elbow X-ray, 3 or more views | 48 | $27.31 |
| 73085 | Elbow X-ray with joint dye (arthrogram), reading | 48 | $81.96 |
| 73090 | Forearm X-ray, 2 views | 48 | $23.54 |
| 73092 | Arm X-ray, infant, 2 or more views | 48 | $24.93 |
| 73100 | Wrist X-ray, 2 views | 48 | $27.46 |
| 73110 | Wrist X-ray, 3 or more views | 48 | $33.19 |
| 73115 | Wrist X-ray with joint dye (arthrogram), reading | 48 | $106.51 |
| 73120 | Hand X-ray, 2 views | 48 | $25.07 |
| 73130 | Hand X-ray, 3 or more views | 48 | $30.14 |
| 73140 | Finger X-ray, 2 or more views | 48 | $30.28 |
| 73200 | CT scan of the arm without contrast | 48 | $148.94 |
| 73201 | CT scan of the arm with contrast | 48 | $187.28 |
| 73202 | CT scan of the arm, without then with contrast | 48 | $232.51 |
| 73206 | CT angiogram of the arm | 48 | $262.77 |
| 73218 | MRI of an arm, non-joint, without contrast | 48 | $285.05 |
| 73219 | MRI of the arm (not a joint) with contrast | 48 | $312.62 |
| 73220 | MRI of the arm (not a joint), without then with contrast | 48 | $378.51 |
| 73221 | MRI of an arm joint without contrast | 48 | $199.04 |
| 73222 | MRI of an arm joint with contrast | 48 | $303.26 |
| 73223 | MRI of an arm joint, without then with contrast | 48 | $378.51 |
| 73225 | MR angiogram of the arm | 46 | $319.41 |
| 73501 | Hip X-ray with pelvis, single view | 47 | $26.37 |
| 73502 | Hip X-ray, 2-3 views | 47 | $37.81 |
| 73503 | Hip X-ray with pelvis, 4 or more views | 47 | $48.35 |
| 73521 | X-ray of both hips, 2 views | 47 | $33.16 |
| 73522 | X-ray of both hips, 3 or 4 views | 47 | $42.60 |
| 73523 | X-ray of both hips, 5 or more views | 47 | $48.90 |
| 73525 | Hip X-ray with joint dye (arthrogram), reading | 48 | $104.20 |
| 73551 | X-ray of the thigh bone, 2 or more views | 47 | $23.38 |
| 73552 | Thigh bone (femur) X-ray, 2 or more views | 47 | $28.29 |
| 73560 | Knee X-ray, 1-2 views | 48 | $27.27 |
| 73562 | Knee X-ray, 3 views | 48 | $33.88 |
| 73564 | Knee X-ray, 4 or more views | 48 | $38.59 |
| 73565 | Both knees X-ray, standing | 48 | $32.59 |
| 73580 | Knee X-ray with joint dye (arthrogram), reading | 48 | $98.24 |
| 73590 | Lower leg (tibia and fibula) X-ray, 2 views | 48 | $25.41 |
| 73592 | Leg X-ray, infant, 2 or more views | 48 | $24.93 |
| 73600 | Ankle X-ray, 2 views | 48 | $25.80 |
| 73610 | Ankle X-ray, 3 or more views | 48 | $29.60 |
| 73615 | Ankle X-ray with joint dye (arthrogram), reading | 48 | $102.88 |
| 73620 | Foot X-ray, 2 views | 48 | $23.27 |
| 73630 | Foot X-ray, 3 or more views | 48 | $27.22 |
| 73650 | Heel X-ray, 2 or more views | 48 | $23.00 |
| 73660 | Toe X-ray, 2 or more views | 48 | $23.14 |
| 73700 | CT scan of the leg without contrast | 48 | $120.93 |
| 73701 | CT scan of the leg with contrast | 48 | $158.99 |
| 73702 | CT scan of the leg, without then with contrast | 48 | $182.47 |
| 73706 | CT angiogram of the leg | 48 | $266.15 |
| 73718 | MRI of a leg, non-joint, without contrast | 48 | $220.82 |
| 73719 | MRI of the leg (not a joint) with contrast | 48 | $259.38 |
| 73720 | MRI of the leg (not a joint), without then with contrast | 48 | $334.16 |
| 73721 | MRI of a lower-body joint (hip or knee) without contrast | 48 | $198.97 |
| 73722 | MRI of a leg joint with contrast | 48 | $305.85 |
| 73723 | MRI of a leg joint, without then with contrast | 48 | $378.51 |
| 73725 | MR angiogram of the leg | 48 | $327.18 |
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.