Imaging prices at Chicot Memorial Medical Center

Lake Village, AR · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $218 $218 2.8×
Abdomen 2 views (74019) $281 $281 3.0×
Ankle 2 views (73600) $287 $287 3.6×
Bone age studies (77072) $287 $287 3.0×
Bone survey infant (77076) $900 $900 9.5×
Chest 1 view (71045) $218 $218 2.8×
Chest 2 views (71046) $218 $218 2.8×
Clavicle complete (73000) $218 $218 2.8×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $278 $278 2.9×
Contrast X-Ray Bladder (74430) $955 $955 3.0×
CT abdomen and pelvis without and with contrast (74178) $1,550 $1,550 4.9×
CT abdomen and pelvis without contrast (74176) $1,350 $1,350 6.2×
CT abdomen w contrast (74160) $1,125 $1,125 7.0×
CT abdomen w wo contrast (74170) $1,125 $1,125 7.0×
CT abdomen w/o contrast (74150) $1,125 $1,125 11.8×
CT Angio Abdomen and Pelvis (74174) $1,200 $1,200 3.8×
CT Angio Chest (71275) $1,125 $1,125 7.0×
CT Angio Head (70496) $1,300 $1,300 8.1×
CT Angio Neck (70498) $1,300 $1,300 8.1×
Ct Angio Upr Extrm W/O&W/Dye (73206) $457 $457 2.9×
CT bone density (77078) $1,000 $1,000 12.6×
CT cervical spine w/o contrast (72125) $1,335.85 $1,335.85 14.0×
CT chest w contrast (71260) $1,335.85 $1,335.85 8.4×
CT chest w/wo contrast (71270) $1,803.25 $1,803.25 11.3×
CT head/brain with contrast (70460) $1,333.85 $1,333.85 8.4×
CT head/brain without and with contrast (70470) $1,402.50 $1,402.50 8.8×
CT l-spine w&w/o contrast (72133) $1,400 $1,400 8.8×
CT lower ext w/o (73700) $1,129.50 $1,129.50 11.9×
CT lower extremity w/contrast material (73701) $661.68 $661.68 4.1×
CT lumbar spine w contrast (72132) $1,400 $1,400 4.4×
CT lumbar spine w/o contrast (72131) $1,335.85 $1,335.85 14.0×
CT maxillofacial w contrast (70487) $2,250 $2,250 14.1×
CT maxillofacial wo contrast (70486) $1,125 $1,125 11.8×
CT neck tissue combo (70492) $1,402.50 $1,402.50 8.8×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,402.50 $1,402.50 8.8×
CT orbits w/o contrast (70480) $1,125 $1,125 11.8×
CT pelvis w&w/o contrast (72194) $1,549.30 $1,549.30 9.7×
CT pelvis w/o contrast (72192) $1,226.40 $1,226.40 12.9×
CT scan of leg combo (73702) $1,600 $1,600 10.0×
CT scans face/jaw combo (70488) $1,400 $1,400 8.8×
CT soft tissue neck w contrast (70491) $1,502.45 $1,502.45 9.4×
CT soft tissue neck w/o contrast (70490) $1,335.85 $1,335.85 14.0×
CT thoracic spine w/o contrast (72128) $1,335.85 $1,335.85 14.0×
CT thoracic spine w/wo cont (72130) $2,760 $2,760 17.3×
CT thorax w/o contrast (71250) $1,423.30 $1,423.30 15.0×
CT upper ext wo (73200) $966.90 $966.90 10.2×
CT upper extremity w/o & w/contrast material (73202) $1,600 $1,600 10.0×
CT upper extremity with contrast (73201) $955 $955 3.0×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $1,125 $1,125 7.0×
Cta Abdomen (74175) $1,500 $1,500 9.4×
Esophagram (74220) $632 $632 4.0×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $300 $300 3.2×
Fluoroscopy up to 1 hr (76000) $588 $588 2.7×
Forearm 2 views (73090) $218 $218 2.8×
Hand 2 views (73120) $287 $287 3.0×
Knee 3 Views (73562) $218 $218 2.8×
Magnetic Image Jaw Joint (70336) $1,980 $1,980 9.1×
MRA head w/o contrast (70544) $1,980 $1,980 9.1×
MRA neck w contrast (70548) $2,200 $2,200 6.9×
Mra Neck W/O &W/Contrast Material (70549) $2,200 $2,200 6.9×
MRA neck w/o contrast (70547) $1,980 $1,980 9.1×
MRI abdomen w contrast (74182) $2,420 $2,420 7.6×
MRI abdomen w/o contrast (74181) $1,980 $1,980 9.1×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $2,420 $2,420 7.6×
MRI any jt upper extremity w/contrast matrl (73222) $2,200 $2,200 3.1×
MRI cervical spine w contrast (72142) $2,200 $2,200 6.9×
MRI cervical spine w/o cont (72141) $1,800 $1,800 8.3×
MRI chest w/o contrast (71550) $1,800 $1,800 8.3×
MRI chest with contrast (71551) $2,200 $2,200 3.1×
MRI chest wo w contrast (71552) $2,200 $2,200 6.9×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $2,420 $2,420 7.6×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,980 $1,980 9.1×
MRI lumbar spine w contrast (72149) $2,200 $2,200 6.9×
Mri Neck Spine W/O & W/Dye (72156) $2,420 $2,420 7.6×
MRI orbit face &/neck w/o contrast (70540) $1,800 $1,800 8.3×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $2,200 $2,200 6.9×
MRI pelvis w contrast (72196) $2,200 $2,200 6.9×
MRI pelvis w/o & w contrast (72197) $2,200 $2,200 6.9×
MRI pelvis w/o contrast (72195) $1,980 $1,980 9.1×
MRI thoracic spine w/o contrast (72146) $1,980 $1,980 9.1×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,800 $1,800 8.3×
Mri Uppr Extremity W/O&W/Dye (73220) $2,200 $2,200 6.9×
MRI, abdomen, combo (74183) $2,200 $2,200 6.9×
MRI, dorsal spine combo (72157) $2,200 $2,200 6.9×
MRI, dorsal spine contrast (72147) $2,200 $2,200 6.9×
MRI, joint upper extrem (73221) $1,800 $1,800 8.3×
MRI, lumbar spine combo (72158) $2,420 $2,420 7.6×
Neck soft tissue (70360) $218 $218 2.8×
Pelvis 1 or 2 views (72170) $287 $287 3.0×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $287 $287 3.0×
Radex abscess/fistula/sinus tract rs&i (76080) $1,315 $1,315 2.6×
Radex Ankle Complete Minimum 3 Views (73610) $218 $218 2.8×
Radex Calcaneus Minimum 2 Views (73650) $218 $218 2.8×
Radex Facial Bones Complete Minimum 3 Views (70150) $287 $287 3.0×
Radex fingr minimum 2 views (73140) $218 $218 2.8×
Radex foot complete minimum 3 views (73630) $218 $218 2.8×
Radex Hand Minimum 3 Views (73130) $218 $218 2.8×
Radex Nasal Bones Complete Minimum 3 Views (70160) $218 $218 2.8×
Radex Ribs Unilateral 2 Views (71100) $218 $218 2.8×
Radex shoulder complete minimum 2 views (73030) $218 $218 2.8×
Radex Spine 1 View Specify Level (72020) $218 $218 2.8×
Radex Sternum Minimum 2 Views (71120) $218 $218 2.8×
Radex Toe Minimum 2 Views (73660) $218 $218 2.8×
Radex Wrist Complete Minimum 3 Views (73110) $218 $218 2.8×
Radiolog exam mandible compl minimum 4 views (70110) $287 $287 3.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $287 $287 3.0×
Radiologic exam colon double contrast study (74280) $632 $632 4.0×
Radiologic exam colon single contrast study (74270) $632 $632 4.0×
Radiologic exam knee complete 4/more views (73564) $278 $278 2.9×
Radiologic Exam Small Int Single Contrast Study (74250) $457 $457 2.9×
Radiologic exam swallow function contrast study (74230) $290.75 $290.75 1.8×
Radiologic exam upr gi trc double contrast study (74246) $632 $632 4.0×
Radiologic examination femur 1 view (73551) $218 $218 2.8×
Radiologic examination femur minimum 2 views (73552) $218 $218 2.8×
Radiologic examination knee 1/2 views (73560) $218 $218 2.8×
Radiologic examination tibia & fibula 2 views (73590) $218 $218 2.8×
Ribs bilateral 3 views (71110) $289.95 $289.95 3.0×
Scapula (73010) $287 $287 3.0×
Screening Digital Breast Tomosynthesis Bi (77063) $150 $150 6.4×
Shoulder 1 view (73020) $218 $218 2.8×
Shoulder Arthrography (73040) $709.50 $709.50 2.2×
Skull less than 4 views (70250) $287 $287 3.0×
Sternoclavicular joints (71130) $218 $218 2.8×
Thoracic spine 2 views (72070) $287 $287 3.0×
Ultrasound Breast Limited (76642) $275 $275 3.5×
Ultrasound, abdomen limited (76705)
range across 4 matching MRF lines		 $275.80–$287 $275.80–$287 varies
Upper gi w/o kub (74240) $632 $632 4.0×
Urethrocystogram voiding (74455) $300 $300 1.4×
Us breast unilateral complete (76641) $287 $287 3.0×
Us chest (76604) $725 $725 7.6×
Us complete joint (76881) $287 $287 3.0×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $287 $287 3.0×
Us ob detailed single fetus (76811) $588 $588 2.7×
Us ob limited 1 or more fetuses (76815) $287 $287 3.0×
Us ob transvaginal (76817) $343.20 $343.20 3.6×
Us pelvic non ob complete (76856) $307.85 $307.85 3.2×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $287 $287 3.0×
Us preg uterus real time f/u trnsabdl per fetus (76816) $287 $287 3.0×
Us retroperitoneal complete (76770) $281 $281 3.0×
Us scrotum and contents (76870) $292.85 $292.85 3.1×
Us spinal canal and contents (76800) $670 $670 7.0×
Us thyroid (76536) $287 $287 3.0×
Venography extremity unilateral rs&i (75820)
range across 2 matching MRF lines		 $3,591–$3,815 $3,591–$3,815 varies
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $218 $218 2.8×
X-ray antegrade pyelogram tube (74425) $499.14 $499.14 1.6×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $218 $218 2.8×
X-Ray Exam Breast Specimen (76098) $1,315 $1,315 2.6×
X-Ray Exam Entire Spi 1 Vw (72081) $218 $218 2.8×
X-Ray Exam Hip Uni 1 View (73501) $218 $218 2.8×
X-Ray Exam Hip Uni 2-3 Views (73502) $218 $218 2.8×
X-Ray Exam Hip Uni 4/> Views (73503) $281 $281 3.0×
X-Ray Exam Hips Bi 2 Views (73521) $287 $287 3.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $287 $287 3.0×
X-Ray Exam Hips Bi 5/> Views (73523) $210 $210 2.2×
X-Ray Exam L-S Spine Bending (72114) $287 $287 3.0×
X-Ray Exam Neck Spine 2-3 Vw (72040) $218 $218 2.8×
X-Ray Exam Neck Spine 6/>Vws (72052) $268 $268 2.8×
X-Ray Exam Unilat Ribs/Chest (71101) $287 $287 3.0×
X-ray eye for foreign body (70030) $218 $218 2.8×
X-ray humerus (73060) $218 $218 2.8×
X-ray IV pyelogram (ivp) (74400) $632 $632 4.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $218 $218 2.8×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $287 $287 3.0×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $338.75 $338.75 3.6×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $287 $287 3.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $286 $286 3.6×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $218 $218 2.8×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $287 $287 3.0×
X-ray thoracic spine 4 vw (72074) $268 $268 2.8×
X-Ray Tmj Unilat (70328) $218 $218 2.8×
X-Ray Urinary Tract Exam With Contrast Material (74420) $955 $955 3.0×
X-Rays Bone Length Studies (77073) $431.60 $431.60 4.5×
Xr c-spine 4 or 5 views (72050) $287 $287 3.0×
XR Mastoids < 3 Views Bilateral (70120) $287 $287 3.0×
Xr orbits complete 4 views (70200) $287 $287 3.0×

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.