| Code | Description | States | Median rate |
|---|---|---|---|
| 75557 | Heart MRI, structure and function, no contrast | 46 | $260.92 |
| 75559 | Heart MRI with stress imaging, no contrast | 45 | $345.23 |
| 75561 | Heart MRI, without then with contrast | 47 | $354.78 |
| 75563 | Heart MRI with stress imaging, without then with contrast | 45 | $395.14 |
| 75565 | Heart MRI flow mapping (add-on) | 43 | $42.36 |
| 75571 | Coronary calcium score CT scan | 40 | $79.98 |
| 75572 | Heart CT scan with contrast, structure | 45 | $194.08 |
| 75573 | Heart CT scan with contrast, congenital heart disease | 45 | $263.04 |
| 75574 | CT angiogram of the coronary arteries | 46 | $298.81 |
| 75580 | Coronary flow reserve estimate from CT angiogram (FFR-CT) | 37 | $742.07 |
| 75625 | Abdominal aorta X-ray with dye, reading | 48 | $114.97 |
| 75635 | CT angiogram of the abdominal aorta and both legs | 48 | $333.13 |
| 75705 | Spinal artery X-ray with dye, reading | 48 | $236.05 |
| 75710 | Arm or leg artery X-ray with dye, one side, reading | 48 | $135.37 |
| 75716 | Arm or leg artery X-ray with dye, both sides, reading | 48 | $146.15 |
| 75731 | Adrenal artery X-ray with dye, one side, reading | 48 | $138.52 |
| 75733 | Adrenal artery X-ray with dye, both sides, reading | 48 | $157.09 |
| 75736 | Pelvic artery X-ray with dye, reading | 48 | $130.19 |
| 75741 | Lung artery X-ray with dye, one side, reading | 48 | $116.81 |
| 75743 | Lung artery X-ray with dye, both sides, reading | 48 | $133.48 |
| 75756 | Internal mammary artery X-ray with dye, reading | 48 | $147.24 |
| 75774 | Artery X-ray with dye, each added vessel, reading | 47 | $86.32 |
| 75801 | Lymph vessel X-ray with dye, one limb, reading | 47 | $185.26 |
| 75803 | Lymph vessel X-ray with dye, both limbs, reading | 47 | $196.37 |
| 75805 | Lymph vessel X-ray with dye, pelvis, one side, reading | 47 | $199.73 |
| 75807 | Lymph vessel X-ray with dye, pelvis, both sides, reading | 47 | $230.76 |
| 75810 | Spleen and portal vein X-ray with dye, reading | 47 | $392.20 |
| 75820 | Arm or leg vein X-ray with dye, one side, reading | 48 | $86.85 |
| 75822 | Arm or leg vein X-ray with dye, both sides, reading | 48 | $107.47 |
| 75825 | Lower vena cava X-ray with dye, reading | 48 | $103.31 |
| 75827 | Upper vena cava X-ray with dye, reading | 48 | $108.26 |
| 75831 | Kidney vein X-ray with dye, one side, reading | 47 | $109.42 |
| 75833 | Kidney vein X-ray with dye, both sides, reading | 47 | $135.09 |
| 75840 | Adrenal vein X-ray with dye, one side, reading | 47 | $118.00 |
| 75984 | Drainage tube exchange with dye check, reading | 47 | $80.89 |
| 75989 | Imaging guidance for catheter drainage, reading | 48 | $102.34 |
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.