Imaging prices at MyMichigan Medical Center Gladwin

Gladwin, MI · every code in this section with a posted price and a Medicare benchmark.

263 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $124.80 $208 1.4×
Abdomen 2 views (74019) $126.60 $211 1.2×
Acute Gastrointestinal Blood Loss Imaging (78278) $612 $1,020 1.5×
Ankle 2 views (73600) $118.80 $198 1.4×
Artery X-Rays Spine (75705)
likely a partial charge, not the full procedure		 $421.80 $703 0.1×
Arthrogram hip (73525) $543 $905 1.6×
Arthrogram Wrist (73115) $543 $905 1.6×
Bone age studies (77072) $124.80 $208 1.2×
Bone Imaging 3 Phase (78315)
range across 2 matching MRF lines		 $942.60–$1,020 $1,571–$1,700 varies
Bone Imaging Limited Area (78300) $558 $930 1.4×
Bone Imaging Whole Body (78306) $865.20 $1,442 2.2×
Bone marrow imaging limited area (78102) $543.60 $906 1.4×
Bone marrow imaging; multiple areas (78103) $546.60 $911 1.4×
Bone marrow imaging; whole body (78104) $703.80 $1,173 1.8×
Bone survey infant (77076) $124.80 $208 1.2×
Cat Scan Follow-Up Study (76380) $361.20 $602 4.2×
Chest 1 view (71045) $162 $270 1.9×
Chest 2 views (71046)
range across 3 matching MRF lines		 $71.40–$206.40 $119–$344 varies
Chest 3 views (71047) $229.80 $383 2.7×
Chest 4 or more views (71048) $210 $350 2.0×
Clavicle complete (73000) $104.40 $174 1.2×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,476.60 $2,461 14.2×
Contrast X-Ray Bladder (74430) $248.40 $414 0.7×
Contrast X-Ray Of Elbow (73085) $543 $905 1.6×
Contrast X-Ray Of Knee Joint (73580) $543 $905 1.6×
CT abdomen and pelvis without and with contrast (74178) $1,773 $2,955 5.1×
CT abdomen and pelvis without contrast (74176) $1,773 $2,955 7.5×
CT abdomen w contrast (74160) $1,156.20 $1,927 6.6×
CT abdomen w wo contrast (74170) $1,300.80 $2,168 7.4×
CT abdomen w/o contrast (74150) $1,012.20 $1,687 9.7×
CT Angio Abdomen and Pelvis (74174) $2,104.80 $3,508 6.1×
CT Angio Chest (71275) $1,228.80 $2,048 7.0×
CT Angio Head (70496) $1,228.80 $2,048 7.0×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,300.80 $2,168 7.4×
CT Angio Neck (70498) $1,228.80 $2,048 7.0×
Ct Angio Upr Extrm W/O&W/Dye (73206) $1,300.80 $2,168 7.4×
CT bone density (77078) $120.60 $201 1.4×
CT cervical spine w/ contrast (72126) $1,084.80 $1,808 3.1×
CT cervical spine w/o contrast (72125) $1,156.20 $1,927 11.1×
CT cervical spine w/wo cont (72127) $1,156.20 $1,927 6.6×
CT chest w contrast (71260) $1,156.20 $1,927 6.6×
CT chest w/wo contrast (71270) $1,518 $2,530 8.7×
CT head/brain with contrast (70460) $1,012.20 $1,687 5.8×
CT head/brain without and with contrast (70470) $1,012.20 $1,687 5.8×
CT heart contrast eval cardiac structure&morph (75572) $546 $910 1.6×
CT heart no contrast quant eval coronry calcium (75571) $59.40 $99 0.7×
CT iac w contrast (70481) $1,269.60 $2,116 7.3×
CT l-spine w&w/o contrast (72133) $1,156.20 $1,927 6.6×
CT lower ext w/o (73700) $1,084.80 $1,808 10.4×
CT lower extremity w/contrast material (73701) $1,012.20 $1,687 5.8×
CT lumbar spine w contrast (72132) $1,084.80 $1,808 3.1×
CT lumbar spine w/o contrast (72131) $1,084.80 $1,808 10.4×
CT maxillofacial w contrast (70487) $1,012.20 $1,687 5.8×
CT maxillofacial wo contrast (70486) $1,156.20 $1,927 11.1×
CT neck tissue combo (70492) $1,084.80 $1,808 6.2×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,228.80 $2,048 7.0×
CT orbits w/o contrast (70480) $1,012.20 $1,687 9.7×
CT pelvis w&w/o contrast (72194) $1,228.80 $2,048 7.0×
CT pelvis w/o contrast (72192) $1,084.80 $1,808 10.4×
CT scan of leg combo (73702) $1,273.20 $2,122 7.3×
CT scans face/jaw combo (70488) $1,446.60 $2,411 8.3×
CT soft tissue neck w contrast (70491) $1,012.20 $1,687 5.8×
CT soft tissue neck w/o contrast (70490) $1,012.20 $1,687 9.7×
CT thoracic spine w contrast (72129) $1,084.80 $1,808 6.2×
CT thoracic spine w/o contrast (72128) $1,084.80 $1,808 10.4×
CT thoracic spine w/wo cont (72130) $1,182 $1,970 6.8×
CT thorax w/o contrast (71250) $1,084.80 $1,808 10.4×
CT upper ext wo (73200) $1,012.20 $1,687 9.7×
CT upper extremity w/o & w/contrast material (73202) $1,084.80 $1,808 6.2×
CT upper extremity with contrast (73201) $1,084.80 $1,808 3.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,191.60 $1,986 6.8×
Cta Abdomen (74175) $1,300.80 $2,168 7.4×
CTA pelvis (72191) $1,300.80 $2,168 7.4×
Discography Cerv/Thor Spine (72285) $2,797.20 $4,662 1.4×
Diskography lumbar (72295) $2,797.20 $4,662 1.4×
Dxa Bone Density Axial (77080) $266.40 $444 2.6×
Dxa bone density study (77085) $266.40 $444 2.6×
Echo Guide For Artery Repair (76936) $489.60 $816 2.3×
Esophagram (74220) $286.20 $477 1.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $232.20 $387 2.2×
Fluoroscopy up to 1 hr (76000) $198 $330 0.8×
Foot 2 views (73620) $118.80 $198 1.4×
Forearm 2 views (73090) $130.20 $217 1.5×
Gastric emptying imaging study (78264) $623.40 $1,039 1.6×
Gated Heart Planar Single (78472) $1,300.20 $2,167 3.3×
Hand 2 views (73120) $112.20 $187 1.1×
Hepatobil Syst Image W/Drug (78227) $744.60 $1,241 1.4×
Hepatobiliary System Imaging (78226) $675.60 $1,126 1.7×
Ht Muscle Image Spect Sing (78451) $1,719 $2,865 1.3×
K Flow/Funct Image Multiple (78709) $730.80 $1,218 1.4×
K Flow/Funct Image W/Drug (78708) $730.80 $1,218 1.4×
K Flow/Funct Image W/O Drug (78707) $730.80 $1,218 1.4×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $489 $815 1.2×
Knee 3 Views (73562) $166.20 $277 1.9×
Liver & Spleen Imaging Static Only (78215) $759.60 $1,266 1.9×
Lung perfusion differential (78597) $577.80 $963 1.5×
Lung Ventilat&Perfus Imaging (78582) $1,194.60 $1,991 2.2×
Lung Ventilation Imaging (78579) $489 $815 1.2×
Lymph System Imaging (78195) $588 $980 1.1×
Magnetic Image Jaw Joint (70336) $1,300.80 $2,168 5.5×
Mr safety determination physician/other qhp (76016) $137.40 $229 1.6×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $37.20 $62 1.3×
Mr safety implt electronics prepj supvj phys/qhp (76018) $140.40 $234 1.5×
Mr safety implt pos&/immoblj (76019) $90.60 $151 1.5×
Mr safety med physics xm customization plng&mntr (76017) $371.40 $619 1.6×
Mra Head W/O & W/Contrast Material (70546) $1,228.80 $2,048 3.5×
MRA head w/o contrast (70544) $1,228.80 $2,048 5.2×
MRA head with contrast (70545) $1,228.80 $2,048 3.5×
MRA neck w contrast (70548) $1,228.80 $2,048 3.5×
Mra Neck W/O &W/Contrast Material (70549) $1,228.80 $2,048 3.5×
MRA neck w/o contrast (70547) $1,228.80 $2,048 5.2×
MRI abdomen w contrast (74182) $1,590 $2,650 4.6×
MRI abdomen w/o contrast (74181) $1,300.80 $2,168 5.5×
MRI any jt lower extrem w/contrast material (73722) $1,446.60 $2,411 1.9×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,662.60 $2,771 4.8×
MRI any jt upper extremity w/contrast matrl (73222) $1,446.60 $2,411 1.9×
MRI cardiac w/o cont stress (75559) $1,918.20 $3,197 3.5×
MRI cervical spine w contrast (72142) $1,300.80 $2,168 3.7×
MRI cervical spine w/o cont (72141) $1,084.80 $1,808 4.6×
MRI chest w/o contrast (71550) $1,300.80 $2,168 5.5×
MRI chest with contrast (71551) $1,446.60 $2,411 1.9×
MRI chest wo w contrast (71552) $1,590 $2,650 4.6×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,446.60 $2,411 4.2×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,662.60 $2,771 4.8×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,156.20 $1,927 4.9×
MRI lumbar spine w contrast (72149) $1,300.80 $2,168 3.7×
Mri Neck Spine W/O & W/Dye (72156) $1,662.60 $2,771 4.8×
MRI orbit face &/neck w/o contrast (70540) $1,228.80 $2,048 5.2×
MRI orbit face neck w contrast (70542) $1,518 $2,530 4.4×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,734.60 $2,891 5.0×
MRI pelvis w contrast (72196) $1,446.60 $2,411 4.2×
MRI pelvis w/o & w contrast (72197) $1,662.60 $2,771 4.8×
MRI pelvis w/o contrast (72195)
range across 2 matching MRF lines		 $1,012.20–$1,156.20 $1,687–$1,927 varies
MRI thoracic spine w/o contrast (72146) $1,084.80 $1,808 4.6×
MRI upper extremity oth than jt w/contr matrl (73219) $1,815 $3,025 5.2×
MRI upper extremity oth than jt w/o contr matrl (73218)
range across 3 matching MRF lines		 $1,156.20–$1,436.40 $1,927–$2,394 varies
Mri Uppr Extremity W/O&W/Dye (73220)
range across 3 matching MRF lines		 $1,662.60–$2,080.80 $2,771–$3,468 varies
MRI, abdomen, combo (74183) $1,807.20 $3,012 5.2×
MRI, dorsal spine combo (72157) $1,807.20 $3,012 5.2×
MRI, dorsal spine contrast (72147) $1,300.80 $2,168 3.7×
MRI, joint upper extrem (73221) $1,084.80 $1,808 4.6×
MRI, joint upper extrem combo (73223) $1,662.60 $2,771 4.8×
MRI, lumbar spine combo (72158) $1,662.60 $2,771 4.8×
Myocardial Spect Multiple Studies (78452) $2,069.40 $3,449 1.6×
Neck soft tissue (70360) $126.60 $211 1.5×
Parathyroid planar imaging w/wo subtraction (78071) $393 $655 1.0×
Pelvis 1 or 2 views (72170) $112.20 $187 1.1×
Pulmonary Perfusion Imaging Particulate (78580) $489 $815 1.2×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $254.40 $424 2.4×
Radex Ankle Complete Minimum 3 Views (73610) $141 $235 1.6×
Radex Calcaneus Minimum 2 Views (73650) $130.20 $217 1.5×
Radex elbow complete minimum 3 views (73080) $130.20 $217 1.5×
Radex Facial Bones Complete Minimum 3 Views (70150) $178.20 $297 1.7×
Radex fingr minimum 2 views (73140) $104.40 $174 1.2×
Radex foot complete minimum 3 views (73630) $154.20 $257 1.8×
Radex Hand Minimum 3 Views (73130) $130.20 $217 1.5×
Radex lower extremity infant minimum 2 views (73592) $104.40 $174 1.2×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $244.20 $407 2.3×
Radex Nasal Bones Complete Minimum 3 Views (70160) $118.80 $198 1.4×
Radex Ribs Unilateral 2 Views (71100) $155.40 $259 1.8×
Radex shoulder complete minimum 2 views (73030) $165 $275 1.9×
Radex Sinuses Paransl < 3 Views (70210) $157.20 $262 1.8×
Radex sm int w/mlt srl imges via enteroclss tube (74251) $231 $385 1.3×
Radex Spine 1 View Specify Level (72020) $97.20 $162 1.1×
Radex Sternum Minimum 2 Views (71120) $126.60 $211 1.5×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $96.60 $161 1.1×
Radex Toe Minimum 2 Views (73660) $104.40 $174 1.2×
Radex upper extremity infant minimum 2 views (73092) $112.20 $187 1.1×
Radex Wrist Complete Minimum 3 Views (73110) $138.60 $231 1.6×
Radiolog exam mandible compl minimum 4 views (70110) $178.20 $297 1.7×
Radiologic exam colon double contrast study (74280) $477.60 $796 2.7×
Radiologic exam colon single contrast study (74270) $376.20 $627 2.2×
Radiologic Exam Esophagus Double Contrast Study (74221) $283.80 $473 1.6×
Radiologic exam knee complete 4/more views (73564) $183 $305 1.8×
Radiologic exam pelvis compl minimum 3 views (72190) $183 $305 1.8×
Radiologic Exam Small Int Single Contrast Study (74250) $244.20 $407 1.4×
Radiologic exam upr gi trc double contrast study (74246) $457.80 $763 2.6×
Radiologic examination femur 1 view (73551) $106.20 $177 1.2×
Radiologic examination femur minimum 2 views (73552) $175.80 $293 2.0×
Radiologic examination knee 1/2 views (73560) $118.80 $198 1.4×
Radiologic Examination Osseous Survey Limited (77074) $174 $290 1.7×
Radiologic examination tibia & fibula 2 views (73590) $137.40 $229 1.6×
Ribs bilateral 3 views (71110) $204.60 $341 2.0×
Rp loclzj tum plnr 1 area single day imaging (78800) $810 $1,350 2.0×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $591.60 $986 1.5×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $2,043.60 $3,406 3.8×
Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) $957 $1,595 1.8×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803)
range across 6 matching MRF lines		 $742.80–$2,043.60 $1,238–$3,406 varies
Rp loclzj tum spect 2 area/sep acquisj img (78831) $2,043.60 $3,406 1.6×
Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) $2,319 $3,865 1.6×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $2,043.60 $3,406 1.6×
Scapula (73010) $124.80 $208 1.2×
Screening Digital Breast Tomosynthesis Bi (77063) $40.80 $68 1.7×
Shoulder 1 view (73020) $106.20 $177 1.2×
Shoulder Arthrography (73040) $543 $905 1.6×
Skull less than 4 views (70250) $171 $285 1.6×
Speech evaluation, complex (70371) $259.20 $432 1.1×
Sternoclavicular joints (71130) $118.80 $198 1.4×
Tbs technical calculation only (77091) $135 $225 1.6×
Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) $448.20 $747 2.6×
Thoracic spine 2 views (72070) $140.40 $234 1.3×
Thoracic spine 3 views (72072) $178.20 $297 1.7×
Thyroid Uptake Measurement (78012) $574.20 $957 1.4×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $481.20 $802 1.2×
Ultrasound Breast Limited (76642) $261 $435 3.0×
Ultrasound Exam Aaa Screen (76706) $565.80 $943 5.4×
Ultrasound, abdomen limited (76705) $360.60 $601 3.5×
Umbilical-artery Doppler (OB) (76820) $121.20 $202 1.2×
Unlisted Dx Radiographic Procedure (76499) $98.40 $164 1.1×
Unlisted fluoroscopic procedure (76496) $106.20 $177 1.2×
Upper gi w/o kub (74240) $406.80 $678 2.3×
Urethrocystogram voiding (74455) $248.40 $414 1.0×
Us breast unilateral complete (76641) $343.80 $573 3.3×
Us chest (76604) $201.60 $336 1.9×
Us complete joint (76881) $180 $300 1.7×
Us exam, pelvic, limited (76857)
range across 2 matching MRF lines		 $202.80–$516.60 $338–$861 varies
Us kidney transplant (76776) $529.20 $882 5.1×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $501.60 $836 4.8×
Us ob detailed single fetus (76811) $356.40 $594 1.5×
Us ob limited 1 or more fetuses (76815) $227.40 $379 2.2×
Us ob transvaginal (76817) $282 $470 2.7×
Us pelvic non ob complete (76856) $554.40 $924 5.3×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $621 $1,035 6.0×
Us preg uterus real time f/u trnsabdl per fetus (76816) $141 $235 1.4×
Us retroperitoneal complete (76770) $565.20 $942 5.4×
Us retroperitoneal limited (76775) $529.20 $882 5.1×
Us scrotum and contents (76870) $519 $865 5.0×
Us thyroid (76536) $394.80 $658 3.8×
Venography extremity unilateral rs&i (75820) $846.60 $1,411 0.5×
Vertebral fracture assessment via dxa (77086) $63.60 $106 0.7×
Wrist 2 views (73100) $112.20 $187 1.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $130.20 $217 1.5×
X-Ray Bend Only L-S Spine (72120) $95.40 $159 0.9×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $112.20 $187 1.3×
X-Ray Exam Breast Specimen (76098) $70.80 $118 0.1×
X-Ray Exam Entire Spi 1 Vw (72081) $154.80 $258 1.8×
X-Ray Exam Entire Spi 2/3 Vw (72082) $415.20 $692 4.0×
X-Ray Exam Hip Uni 1 View (73501) $205.80 $343 2.4×
X-Ray Exam Hip Uni 2-3 Views (73502) $208.20 $347 2.4×
X-Ray Exam Hips Bi 2 Views (73521) $173.40 $289 1.7×
X-Ray Exam Hips Bi 5/> Views (73523) $208.20 $347 2.0×
X-Ray Exam L-S Spine Bending (72114) $280.20 $467 2.7×
X-Ray Exam Neck Spine 2-3 Vw (72040) $178.20 $297 2.1×
X-Ray Exam Neck Spine 6/>Vws (72052) $215.40 $359 2.1×
X-Ray Exam Unilat Ribs/Chest (71101) $166.20 $277 1.6×
X-ray eye for foreign body (70030) $145.20 $242 1.7×
X-ray humerus (73060) $124.80 $208 1.4×
X-ray IV pyelogram (ivp) (74400) $493.20 $822 2.8×
X-ray IV pyelogram+tomography (74415) $667.80 $1,113 3.8×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $155.40 $259 1.8×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $117.60 $196 1.4×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $178.20 $297 1.7×
X-ray nose-rectum child f.b. (76010) $124.80 $208 1.4×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $244.20 $407 2.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $117.60 $196 1.1×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $137.40 $229 1.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $227.40 $379 2.6×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $234.60 $391 2.3×
X-Rays Bone Length Studies (77073) $124.80 $208 1.2×
X-Rays Bone Survey Complete (77075) $294.60 $491 2.8×
Xr c-spine 4 or 5 views (72050) $197.40 $329 1.9×
Xr facial bones less than 3 views (70140) $157.20 $262 1.8×
Xr orbits complete 4 views (70200) $197.40 $329 1.9×

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.