CHELSEA HOSPITAL Hospital

Legal name: ST JOSEPH MERCY CHELSEA INC

CHELSEA, MI 481181383 (734) 593-6000 283X00000X

Published Procedure Prices

Procedure	CPT	Cash Price	Insurance Range
HC MRI Temporomandibular Joint(S)	70336	$1,521	N/A
HC MRI Orbit/Face/Neck W/O Contrast	70540	$1,696	N/A
HC MRI Orbit/Face/Neck W/Contrast	70542	$2,053	N/A
HC MRI Orbit/Face/Neck W/O & W/Contrast	70543	$2,998	N/A
HC Mra Head W/O Contrast	70544	$1,553	N/A
HC Mra Head W/Contrast	70545	$1,780	N/A
HC Mra Head W/O & W/Contrast	70546	$2,471	N/A
HC Mra Neck W/O Contrast	70547	$890	N/A
HC Mra Neck W/Contrast	70548	$1,502	N/A
HC Mra Neck W/O & W/Contrast	70549	$1,867	N/A
HC MRI Brain W/O Contrast	70551	$2,800	N/A
HC MRI Brain W/Contrast	70552	$2,984	N/A
HC MRI Brain W/O & W/Contrast	70553	$5,097	N/A
HC MRI Chest W/O Contrast	71550	$1,749	N/A
HC MRI Chest W/O & W/Contrast	71552	$2,984	N/A
HC MRI Cervical Spine W/O Contrast	72141	$2,970	N/A
HC MRI Cervical Spine W/Contrast	72142	$3,022	N/A
HC MRI Thoracic Spine W/O Contrast	72146	$2,970	N/A
HC MRI Thoracic Spine W/Contrast	72147	$3,022	N/A
HC MRI Lumbar Spine W/O Contrast	72148	$2,970	N/A
HC MRI Lumbar Spine W/Contrast	72149	$3,022	N/A
HC MRI Cervival Spine W/O & W/Contrast	72156	$4,933	N/A
HC MRI Thoracic Spine W/O & W/Contrast	72157	$4,933	N/A
HC MRI Lumbar Spine W/O & W/Contrast	72158	$4,933	N/A
HC MRI Pelvis W/O Contrast	72195	$1,930	N/A
HC MRI Pelvis W/Contrast	72196	$2,025	N/A
HC MRI Pelvis W/O & W/Contrast	72197	$3,175	N/A
HC MRI Upper Extremity Other Than Joint W/O Contra	73218	$1,748	N/A
HC MRI Upper Extremity Other Than Joint W/O & W/Co	73220	$2,085	N/A
HC MRI Upper Extremity Joint W/O Contrast Bl\|BILAT	73221	$3,871	N/A

Prices shown are published rates from hospital chargemaster files and insurer rate data. Your actual cost depends on your insurance plan, deductible status, and services rendered.