Imaging prices at Choctaw Memorial Hospital

Hugo, OK · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $90 $180 1.1×
Abdomen 2 views (74019) $139 $278 1.4×
Ankle 2 views (73600) $90 $180 1.1×
Chest 1 view (71045) $90 $180 1.1×
Chest 2 views (71046) $105.50 $211 1.3×
Chest 3 views (71047) $122 $244 1.5×
Chest 4 or more views (71048) $132.50 $265 1.3×
Clavicle complete (73000) $90 $180 1.1×
CT abdomen and pelvis without and with contrast (74178)
range across 2 matching MRF lines		 $1,576–$1,631.50 $3,152–$3,263 varies
CT abdomen and pelvis without contrast (74176) $1,321 $2,642 5.8×
CT abdomen w contrast (74160) $1,029.50 $2,059 6.1×
CT abdomen w wo contrast (74170) $1,029.50 $2,059 6.1×
CT abdomen w/o contrast (74150) $1,029.50 $2,059 10.2×
CT Angio Abdomen and Pelvis (74174) $925 $1,850 2.8×
CT Angio Chest (71275) $785 $1,570 4.7×
CT Angio Head (70496) $690.50 $1,381 4.1×
Ct Angio Lwr Extr W/O&W/Dye (73706) $705.50 $1,411 4.2×
CT Angio Neck (70498) $690.50 $1,381 4.1×
Ct Angio Upr Extrm W/O&W/Dye (73206)
range across 2 matching MRF lines		 $705.50–$1,066 $1,411–$2,132 varies
CT cervical spine w/ contrast (72126) $681 $1,362 2.0×
CT cervical spine w/o contrast (72125) $664.50 $1,329 6.6×
CT cervical spine w/wo cont (72127) $938 $1,876 5.6×
CT chest w contrast (71260) $715 $1,430 4.2×
CT chest w/wo contrast (71270) $877.50 $1,755 5.2×
CT head/brain with contrast (70460) $790 $1,580 4.7×
CT head/brain without and with contrast (70470) $790 $1,580 4.7×
CT heart no contrast quant eval coronry calcium (75571) $90 $180 1.1×
CT iac w contrast (70481) $620 $1,240 3.7×
CT l-spine w&w/o contrast (72133) $822.50 $1,645 4.9×
CT lower ext w/o (73700) $527 $1,054 5.2×
CT lower extremity w/contrast material (73701) $604.50 $1,209 3.6×
CT lumbar spine w contrast (72132) $840 $1,680 2.5×
CT lumbar spine w/o contrast (72131) $829 $1,658 8.2×
CT maxillofacial w contrast (70487) $620 $1,240 3.7×
CT maxillofacial wo contrast (70486) $610 $1,220 6.1×
CT neck tissue combo (70492) $850 $1,700 5.0×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $741 $1,482 4.4×
CT orbits w/o contrast (70480) $530.50 $1,061 5.3×
CT pelvis w&w/o contrast (72194) $1,079.50 $2,159 6.4×
CT pelvis w/o contrast (72192) $979.50 $1,959 9.7×
CT scan of leg combo (73702) $657.50 $1,315 3.9×
CT scans face/jaw combo (70488) $733 $1,466 4.3×
CT soft tissue neck w contrast (70491) $620 $1,240 3.7×
CT soft tissue neck w/o contrast (70490) $530.50 $1,061 5.3×
CT thoracic spine w contrast (72129) $740 $1,480 4.4×
CT thoracic spine w/o contrast (72128) $738 $1,476 7.3×
CT thoracic spine w/wo cont (72130) $822.50 $1,645 4.9×
CT thorax w/o contrast (71250) $699.50 $1,399 7.0×
CT upper ext wo (73200) $527 $1,054 5.2×
CT upper extremity w/o & w/contrast material (73202) $662 $1,324 3.9×
CT upper extremity with contrast (73201) $583 $1,166 1.7×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635)
range across 2 matching MRF lines		 $981.50–$1,066 $1,963–$2,132 varies
Cta Abdomen (74175) $765.50 $1,531 4.5×
CTA pelvis (72191) $765.50 $1,531 4.5×
Foot 2 views (73620) $90 $180 1.1×
Forearm 2 views (73090) $90 $180 1.1×
Hand 2 views (73120) $169.50 $339 1.7×
Joint Survey Single View (77077) $169.50 $339 1.7×
Knee 3 Views (73562) $107.50 $215 1.3×
Neck soft tissue (70360) $90 $180 1.1×
Optic foramina (70190) $90 $180 1.1×
Pelvis 1 or 2 views (72170) $169.50 $339 1.7×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $169.50 $339 1.7×
Radex Ankle Complete Minimum 3 Views (73610) $97.50 $195 1.2×
Radex Calcaneus Minimum 2 Views (73650) $90 $180 1.1×
Radex elbow complete minimum 3 views (73080) $90 $180 1.1×
Radex Facial Bones Complete Minimum 3 Views (70150) $169.50 $339 1.7×
Radex fingr minimum 2 views (73140) $90 $180 1.1×
Radex foot complete minimum 3 views (73630) $97.50 $195 1.2×
Radex Hand Minimum 3 Views (73130) $182.50 $365 2.2×
Radex lower extremity infant minimum 2 views (73592) $90 $180 1.1×
Radex Mastoids Compl Minimum 3 Views PR Side (70130) $169.50 $339 1.7×
Radex Nasal Bones Complete Minimum 3 Views (70160) $90 $180 1.1×
Radex Ribs Unilateral 2 Views (71100) $136.50 $273 1.6×
Radex shoulder complete minimum 2 views (73030) $140 $280 1.7×
Radex Sinuses Paransl < 3 Views (70210) $90 $180 1.1×
Radex Spine 1 View Specify Level (72020) $90 $180 1.1×
Radex Sternum Minimum 2 Views (71120) $189.50 $379 2.3×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $153 $306 1.8×
Radex Toe Minimum 2 Views (73660) $90 $180 1.1×
Radex Wrist Complete Minimum 3 Views (73110) $92.50 $185 1.1×
Radiolog exam mandible compl minimum 4 views (70110) $169.50 $339 1.7×
Radiologic exam knee complete 4/more views (73564) $169.50 $339 1.7×
Radiologic exam pelvis compl minimum 3 views (72190) $169.50 $339 1.7×
Radiologic Exam Small Int Single Contrast Study (74250) $169.50 $339 1.0×
Radiologic examination femur 1 view (73551) $90 $180 1.1×
Radiologic examination femur minimum 2 views (73552) $90 $180 1.1×
Radiologic examination knee 1/2 views (73560) $90 $180 1.1×
Radiologic Examination Osseous Survey Limited (77074) $169.50 $339 1.7×
Radiologic examination tibia & fibula 2 views (73590) $90 $180 1.1×
Ribs bilateral 3 views (71110) $285 $570 2.8×
Scapula (73010) $90 $180 0.9×
Shoulder 1 view (73020) $90 $180 1.1×
Skull less than 4 views (70250) $169.50 $339 1.7×
Sternoclavicular joints (71130) $240 $480 2.9×
Thoracic spine 2 views (72070) $169.50 $339 1.7×
Thoracic spine 3 views (72072) $169.50 $339 1.7×
Ultrasound Breast Limited (76642)
range across 4 matching MRF lines		 $22.50–$148 $45–$296 varies
Ultrasound, abdomen limited (76705) $202 $404 2.0×
Unlisted us procedure (76999) $135 $270 1.6×
Us breast unilateral complete (76641) $169.50 $339 1.7×
Us chest (76604) $202 $404 2.0×
Us complete joint (76881) $202 $404 2.0×
Us exam, pelvic, limited (76857) $92.50 $185 0.9×
Us ob limited 1 or more fetuses (76815) $202 $404 2.0×
Us ob transvaginal (76817) $202 $404 2.0×
Us pelvic non ob complete (76856) $208.50 $417 2.1×
Us preg uterus real time f/u trnsabdl per fetus (76816) $169.50 $339 1.7×
Us retroperitoneal complete (76770) $202 $404 2.0×
Us retroperitoneal limited (76775) $202 $404 2.0×
Us scrotum and contents (76870) $202 $404 2.0×
Us thyroid (76536) $202 $404 2.0×
Wrist 2 views (73100) $90 $180 1.1×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $90 $180 1.1×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $90 $180 1.1×
X-Ray Exam Entire Spi 1 Vw (72081) $90 $180 1.1×
X-Ray Exam Hip Uni 1 View (73501) $90 $180 1.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $100 $200 1.2×
X-Ray Exam Hips Bi 5/> Views (73523) $339 $678 3.4×
X-Ray Exam Neck Spine 2-3 Vw (72040) $136.50 $273 1.6×
X-Ray Exam Neck Spine 6/>Vws (72052) $178 $356 1.8×
X-Ray Exam Unilat Ribs/Chest (71101) $169.50 $339 1.7×
X-ray humerus (73060) $90 $180 1.1×
X-ray IV pyelogram (ivp) (74400) $386.50 $773 2.3×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $90 $180 1.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $108.50 $217 1.3×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $169.50 $339 1.7×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $169.50 $339 1.7×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $169.50 $339 1.7×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $90 $180 1.1×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $162.50 $325 1.9×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $169.50 $339 1.7×
X-ray thoracic spine 4 vw (72074) $169.50 $339 1.7×
X-Ray Tmj Unilat (70328) $98 $196 1.2×
X-Rays Bone Length Studies (77073) $247.50 $495 2.5×
X-Rays Bone Survey Complete (77075) $312 $624 3.1×
Xr c-spine 4 or 5 views (72050) $169.50 $339 1.7×
Xr facial bones less than 3 views (70140) $90 $180 1.1×
XR Mastoids < 3 Views Bilateral (70120) $169.50 $339 1.7×
Xr orbits complete 4 views (70200) $169.50 $339 1.7×

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.