Imaging prices at MyMichigan Medical Center Sault

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $102.60 $171 1.2×
Abdomen 2 views (74019) $102.60 $171 1.0×
Ankle 2 views (73600) $102.60 $171 1.2×
Arthrogram ankle (73615) $484.80 $808 1.4×
Arthrogram hip (73525) $484.80 $808 1.4×
Arthrogram Wrist (73115) $484.80 $808 1.4×
Bone age studies (77072) $102.60 $171 1.0×
Bone Imaging 3 Phase (78315) $627 $1,045 1.6×
Bone Imaging Whole Body (78306) $587.40 $979 1.5×
Bone survey infant (77076) $176.40 $294 1.7×
Brain Imaging Pet Metabolic Evaluation (78608) $2,407.80 $4,013 1.7×
Chest 1 view (71045) $102.60 $171 1.2×
Chest 2 views (71046) $102.60 $171 1.2×
Chest 3 views (71047) $102.60 $171 1.2×
Chest 4 or more views (71048) $180 $300 1.7×
Clavicle complete (73000) $102.60 $171 1.2×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $135.60 $226 1.3×
Contrast X-Ray Bladder (74430) $376.80 $628 1.1×
Contrast X-Ray Of Elbow (73085) $484.80 $808 1.4×
Contrast X-Ray Of Knee Joint (73580) $484.80 $808 1.4×
CT abdomen and pelvis without and with contrast (74178) $1,560 $2,600 4.5×
CT abdomen and pelvis without contrast (74176) $928.80 $1,548 3.9×
CT abdomen w contrast (74160) $603 $1,005 3.5×
CT abdomen w wo contrast (74170) $742.20 $1,237 4.2×
CT abdomen w/o contrast (74150) $450.60 $751 4.3×
CT Angio Abdomen and Pelvis (74174) $946.80 $1,578 2.7×
CT Angio Chest (71275) $856.80 $1,428 4.9×
CT Angio Head (70496) $654.60 $1,091 3.7×
CT angio hrt w/3d image (75574) $644.40 $1,074 1.9×
Ct Angio Lwr Extr W/O&W/Dye (73706) $1,300.80 $2,168 7.4×
CT Angio Neck (70498) $654.60 $1,091 3.7×
Ct Angio Upr Extrm W/O&W/Dye (73206) $654.60 $1,091 3.7×
CT cervical spine w/ contrast (72126) $823.80 $1,373 2.4×
CT cervical spine w/o contrast (72125) $759.60 $1,266 7.3×
CT cervical spine w/wo cont (72127) $873 $1,455 5.0×
CT chest w contrast (71260) $657 $1,095 3.8×
CT chest w/wo contrast (71270) $873 $1,455 5.0×
CT head/brain with contrast (70460) $1,012.20 $1,687 5.8×
CT head/brain without and with contrast (70470) $714 $1,190 4.1×
CT heart no contrast quant eval coronry calcium (75571)
range across 2 matching MRF lines		 $90–$232.20 $150–$387 varies
CT iac w contrast (70481) $138.60 $231 0.8×
CT l-spine w&w/o contrast (72133) $852.60 $1,421 4.9×
CT lower ext w/o (73700) $715.20 $1,192 6.9×
CT lower extremity w/contrast material (73701) $719.40 $1,199 4.1×
CT lumbar spine w contrast (72132) $771 $1,285 2.2×
CT lumbar spine w/o contrast (72131) $759.60 $1,266 7.3×
CT maxillofacial w contrast (70487) $719.40 $1,199 4.1×
CT maxillofacial wo contrast (70486) $715.20 $1,192 6.9×
CT neck tissue combo (70492) $771 $1,285 4.4×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $714 $1,190 4.1×
CT orbits w/o contrast (70480) $716.40 $1,194 6.9×
CT pelvis w&w/o contrast (72194) $826.20 $1,377 4.7×
CT pelvis w/o contrast (72192) $486 $810 4.7×
CT scan of leg combo (73702) $771 $1,285 4.4×
CT scans face/jaw combo (70488) $771 $1,285 4.4×
CT soft tissue neck w contrast (70491) $719.40 $1,199 4.1×
CT soft tissue neck w/o contrast (70490) $715.20 $1,192 6.9×
CT thoracic spine w contrast (72129) $715.20 $1,192 4.1×
CT thoracic spine w/o contrast (72128) $670.20 $1,117 6.4×
CT thoracic spine w/wo cont (72130) $873 $1,455 5.0×
CT thorax w/o contrast (71250) $529.80 $883 5.1×
CT upper ext wo (73200) $771 $1,285 7.4×
CT upper extremity with contrast (73201) $738 $1,230 2.1×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $654.60 $1,091 3.7×
Cta Abdomen (74175) $654.60 $1,091 3.7×
Diskography lumbar (72295) $2,877 $4,795 1.5×
Dxa Bone Density Axial (77080) $168.60 $281 1.6×
Dxa bone density study 1/>sites appendiclr skel (77081) $123.60 $206 1.4×
Esophagram (74220) $208.80 $348 1.2×
Fetal Biophys Profile W/Nst (76818) $234.60 $391 2.3×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $345.60 $576 3.3×
Fluoroscopy up to 1 hr (76000) $368.40 $614 1.5×
Foot 2 views (73620) $102.60 $171 1.2×
Forearm 2 views (73090) $102.60 $171 1.2×
Gastric emptying imaging study (78264) $537 $895 1.3×
Gated Heart Planar Single (78472) $924.60 $1,541 2.3×
Hand 2 views (73120) $205.80 $343 2.0×
Hepatobil Syst Image W/Drug (78227) $606 $1,010 1.1×
Hepatobiliary System Imaging (78226) $606 $1,010 1.5×
Ht Muscle Image Spect Sing (78451) $2,518.80 $4,198 2.0×
Hysterosalpingogram (74740) $451.80 $753 1.9×
Infant hip ultrasound, limited static exam (76886) $100.20 $167 1.2×
K Flow/Funct Image W/Drug (78708) $673.80 $1,123 1.2×
K Flow/Funct Image W/O Drug (78707) $673.80 $1,123 1.2×
Kidney Imaging Morphoogy W/Vascular Flow (78701) $546.60 $911 1.4×
Knee 3 Views (73562) $166.20 $277 1.9×
Liver & Spleen Imaging Static Only (78215) $677.40 $1,129 1.7×
Lung Ventilat&Perfus Imaging (78582) $1,194.60 $1,991 2.2×
Magnetic Image Jaw Joint (70336) $1,751.40 $2,919 7.4×
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 contrast (70544) $1,499.40 $2,499 6.3×
Mra Neck W/O &W/Contrast Material (70549) $2,078.40 $3,464 6.0×
MRA neck w/o contrast (70547) $1,751.40 $2,919 7.4×
MRI abdomen w contrast (74182) $1,794.60 $2,991 5.2×
MRI abdomen w/o contrast (74181) $1,751.40 $2,919 7.4×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,890 $3,150 5.4×
MRI any jt upper extremity w/contrast matrl (73222) $1,420.80 $2,368 1.8×
MRI cervical spine w contrast (72142) $1,300.80 $2,168 3.7×
MRI cervical spine w/o cont (72141) $1,751.40 $2,919 7.4×
MRI chest w/o contrast (71550) $1,751.40 $2,919 7.4×
MRI chest wo w contrast (71552) $1,890 $3,150 5.4×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,890 $3,150 5.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,470.60 $2,451 6.2×
MRI lumbar spine w contrast (72149) $1,300.80 $2,168 3.7×
Mri Neck Spine W/O & W/Dye (72156) $1,890 $3,150 5.4×
MRI orbit face &/neck w/o contrast (70540) $1,228.80 $2,048 5.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,890 $3,150 5.4×
MRI pelvis w contrast (72196) $1,446.60 $2,411 4.2×
MRI pelvis w/o & w contrast (72197) $1,890 $3,150 5.4×
MRI pelvis w/o contrast (72195) $1,751.40 $2,919 7.4×
MRI thoracic spine w/o contrast (72146) $1,751.40 $2,919 7.4×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,470.60 $2,451 6.2×
Mri Uppr Extremity W/O&W/Dye (73220) $1,890 $3,150 5.4×
MRI, abdomen, combo (74183) $1,890 $3,150 5.4×
MRI, dorsal spine combo (72157) $1,890 $3,150 5.4×
MRI, joint upper extrem (73221) $1,420.80 $2,368 6.0×
MRI, joint upper extrem combo (73223) $2,329.20 $3,882 6.7×
MRI, lumbar spine combo (72158) $1,890 $3,150 5.4×
Myocardial Spect Multiple Studies (78452) $2,518.80 $4,198 2.0×
Neck soft tissue (70360) $102.60 $171 1.2×
Parathyroid imaging w/tomographic spect & CT (78072) $975.60 $1,626 1.8×
Parathyroid Planar Imaging (78070) $537 $895 1.3×
Parathyroid planar imaging w/wo subtraction (78071) $2,029.20 $3,382 5.1×
Pelvis 1 or 2 views (72170) $102.60 $171 1.0×
Pet Image W/Ct Lmtd (78814) $3,122.40 $5,204 2.2×
PET image w/CT, full body (78816) $3,239.40 $5,399 2.3×
PET imaging CT attenuation skull base mid-thigh (78815) $3,239.40 $5,399 2.3×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $176.40 $294 1.7×
Radex abscess/fistula/sinus tract rs&i (76080) $245.40 $409 0.5×
Radex Ankle Complete Minimum 3 Views (73610) $102.60 $171 1.2×
Radex Calcaneus Minimum 2 Views (73650) $102.60 $171 1.2×
Radex elbow complete minimum 3 views (73080) $102.60 $171 1.2×
Radex Facial Bones Complete Minimum 3 Views (70150) $125.40 $209 1.2×
Radex fingr minimum 2 views (73140) $102.60 $171 1.2×
Radex foot complete minimum 3 views (73630) $102.60 $171 1.2×
Radex Hand Minimum 3 Views (73130) $102.60 $171 1.2×
Radex lower extremity infant minimum 2 views (73592) $102.60 $171 1.2×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $102.60 $171 1.0×
Radex Nasal Bones Complete Minimum 3 Views (70160) $102.60 $171 1.2×
Radex Ribs Unilateral 2 Views (71100) $102.60 $171 1.2×
Radex shoulder complete minimum 2 views (73030) $102.60 $171 1.2×
Radex Sinuses Paransl < 3 Views (70210) $102.60 $171 1.2×
Radex Spine 1 View Specify Level (72020) $102.60 $171 1.2×
Radex Sternum Minimum 2 Views (71120) $102.60 $171 1.2×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $146.40 $244 1.7×
Radex Toe Minimum 2 Views (73660) $102.60 $171 1.2×
Radex upper extremity infant minimum 2 views (73092) $102.60 $171 1.0×
Radex Wrist Complete Minimum 3 Views (73110) $102.60 $171 1.2×
Radiolog exam mandible compl minimum 4 views (70110) $125.40 $209 1.2×
Radiologic exam colon double contrast study (74280) $322.20 $537 1.8×
Radiologic exam colon single contrast study (74270) $208.80 $348 1.2×
Radiologic Exam Esophagus Double Contrast Study (74221) $86.40 $144 0.5×
Radiologic exam knee complete 4/more views (73564) $198.60 $331 1.9×
Radiologic exam pelvis compl minimum 3 views (72190) $102.60 $171 1.0×
Radiologic Exam Small Int Single Contrast Study (74250) $208.80 $348 1.2×
Radiologic exam swallow function contrast study (74230) $208.80 $348 1.2×
Radiologic exam upr gi trc double contrast study (74246) $259.80 $433 1.5×
Radiologic examination femur 1 view (73551) $151.20 $252 1.7×
Radiologic examination femur minimum 2 views (73552) $102.60 $171 1.2×
Radiologic examination knee 1/2 views (73560) $102.60 $171 1.2×
Radiologic examination tibia & fibula 2 views (73590) $102.60 $171 1.2×
Ribs bilateral 3 views (71110) $185.40 $309 1.8×
Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) $1,975.20 $3,292 3.7×
Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) $2,043.60 $3,406 1.6×
Scapula (73010) $102.60 $171 1.0×
Screening Digital Breast Tomosynthesis Bi (77063) $87 $145 3.7×
Shoulder 1 view (73020) $102.60 $171 1.2×
Shoulder Arthrography (73040) $484.80 $808 1.4×
Skull less than 4 views (70250) $102.60 $171 1.0×
Speech evaluation, complex (70371) $104.40 $174 0.4×
Sternoclavicular joints (71130) $102.60 $171 1.2×
Tbs technical calculation only (77091) $135 $225 1.6×
Thoracic spine 2 views (72070) $153 $255 1.5×
Thoracic spine 3 views (72072) $229.20 $382 2.2×
Thyroid Met Imaging Body (78018) $823.80 $1,373 1.5×
Thyroid Uptake Measurement (78012) $574.20 $957 1.4×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $564 $940 1.4×
Ultrasound Breast Limited (76642) $139.20 $232 1.6×
Ultrasound Exam Aaa Screen (76706) $182.40 $304 1.8×
Ultrasound, abdomen limited (76705) $215.40 $359 2.1×
Umbilical-artery Doppler (OB) (76820) $110.40 $184 1.1×
Unlisted Dx Radiographic Procedure (76499) $98.40 $164 1.1×
Upper gi w/o kub (74240) $196.20 $327 1.1×
Urethrocystogram voiding (74455) $376.80 $628 1.6×
Urethrocystography retrograde (74450) $376.80 $628 1.6×
Us breast unilateral complete (76641) $156 $260 1.5×
Us chest (76604) $106.80 $178 1.0×
Us complete joint (76881) $296.40 $494 2.8×
Us exam, pelvic, limited (76857)
range across 2 matching MRF lines		 $106.80–$133.20 $178–$222 varies
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $106.80 $178 1.0×
Us ob detailed single fetus (76811) $340.20 $567 1.4×
Us ob limited 1 or more fetuses (76815) $198.60 $331 1.9×
Us ob transvaginal (76817) $198.60 $331 1.9×
Us pelvic non ob complete (76856) $240 $400 2.3×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $292.80 $488 2.8×
Us preg uterus real time f/u trnsabdl per fetus (76816) $198.60 $331 1.9×
Us retroperitoneal complete (76770) $301.80 $503 2.9×
Us retroperitoneal limited (76775) $211.80 $353 2.0×
Us scrotum and contents (76870) $215.40 $359 2.1×
Us spinal canal and contents (76800) $215.40 $359 2.1×
Us thyroid (76536) $215.40 $359 2.1×
Us transrectal (76872) $215.40 $359 2.1×
Wrist 2 views (73100) $102.60 $171 1.2×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $102.60 $171 1.2×
X-ray antegrade pyelogram tube (74425) $376.80 $628 1.1×
X-Ray Bend Only L-S Spine (72120) $118.20 $197 1.1×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $102.60 $171 1.2×
X-Ray Exam Breast Specimen (76098) $540 $900 1.0×
X-Ray Exam Entire Spi 1 Vw (72081) $32.40 $54 0.4×
X-Ray Exam Entire Spi 2/3 Vw (72082) $198.60 $331 1.9×
X-Ray Exam Hip Uni 1 View (73501) $102.60 $171 1.2×
X-Ray Exam Hip Uni 2-3 Views (73502) $102.60 $171 1.2×
X-Ray Exam Hips Bi 2 Views (73521) $208.20 $347 2.0×
X-Ray Exam Hips Bi 5/> Views (73523) $102.60 $171 1.0×
X-Ray Exam L-S Spine Bending (72114) $177.60 $296 1.7×
X-Ray Exam Neck Spine 2-3 Vw (72040) $102.60 $171 1.2×
X-Ray Exam Neck Spine 6/>Vws (72052) $279 $465 2.7×
X-Ray Exam Unilat Ribs/Chest (71101) $102.60 $171 1.0×
X-ray eye for foreign body (70030) $102.60 $171 1.2×
X-ray humerus (73060) $102.60 $171 1.2×
X-ray IV pyelogram (ivp) (74400) $438.60 $731 2.5×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $125.40 $209 1.4×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $106.20 $177 1.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $102.60 $171 1.0×
X-ray nose-rectum child f.b. (76010) $83.40 $139 1.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $176.40 $294 1.7×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $69 $115 0.7×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $102.60 $171 1.2×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $125.40 $209 1.4×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $176.40 $294 1.7×
X-ray thoracic spine 4 vw (72074) $511.20 $852 4.9×
X-Ray Urinary Tract Exam With Contrast Material (74420) $376.80 $628 1.1×
X-Rays Bone Length Studies (77073) $102.60 $171 1.0×
X-Rays Bone Survey Complete (77075) $344.40 $574 3.3×
Xr c-spine 4 or 5 views (72050) $198.60 $331 1.9×
Xr orbits complete 4 views (70200) $109.80 $183 1.1×

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.