Imaging prices at Cimarron Memorial Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Abdomen 1 View (74018) $112 $224 1.3×
Abdomen 2 views (74019) $168 $336 1.7×
Angio pulmonary bilat (75743) $3,330 $6,659 1.1×
Ankle 2 views (73600) $168 $336 2.0×
Bone age studies (77072) $141 $281 1.4×
Chest 1 view (71045) $112 $224 1.3×
Chest 2 views (71046) $168 $336 2.0×
Chest 3 views (71047) $196 $392 2.3×
Chest 4 or more views (71048) $224 $448 2.2×
Clavicle complete (73000) $168 $336 2.0×
CT abdomen and pelvis without and with contrast (74178) $1,800 $3,600 5.4×
CT abdomen and pelvis without contrast (74176) $1,220 $2,440 5.3×
CT abdomen w contrast (74160) $1,300 $2,600 7.7×
CT abdomen w wo contrast (74170) $1,800 $3,600 10.7×
CT abdomen w/o contrast (74150) $1,200 $2,400 11.9×
CT cervical spine w/ contrast (72126) $1,300 $2,600 3.9×
CT cervical spine w/o contrast (72125) $1,200 $2,400 11.9×
CT cervical spine w/wo cont (72127) $1,800 $3,600 10.7×
CT chest w contrast (71260) $1,300 $2,600 7.7×
CT chest w/wo contrast (71270) $1,800 $3,600 10.7×
CT head/brain with contrast (70460) $1,300 $2,600 7.7×
CT head/brain without and with contrast (70470) $1,800 $3,600 10.7×
CT iac w contrast (70481) $1,300 $2,600 7.7×
CT l-spine w&w/o contrast (72133) $1,800 $3,600 10.7×
CT lower ext w/o (73700) $1,200 $2,400 11.9×
CT lower extremity w/contrast material (73701) $1,300 $2,600 7.7×
CT lumbar spine w contrast (72132) $1,300 $2,600 3.9×
CT lumbar spine w/o contrast (72131) $1,200 $2,400 11.9×
CT maxillofacial w contrast (70487) $1,300 $2,600 7.7×
CT maxillofacial wo contrast (70486) $1,200 $2,400 11.9×
CT neck tissue combo (70492) $1,800 $3,600 10.7×
Ct Orbit/Ear/Fossa W/O&W/Dye (70482) $1,800 $3,600 10.7×
CT orbits w/o contrast (70480) $1,200 $2,400 11.9×
CT pelvis w&w/o contrast (72194) $1,800 $3,600 10.7×
CT pelvis w/o contrast (72192) $1,200 $2,400 11.9×
CT scan of leg combo (73702) $578 $1,155 3.4×
CT scans face/jaw combo (70488) $1,800 $3,600 10.7×
CT soft tissue neck w contrast (70491) $1,300 $2,600 7.7×
CT soft tissue neck w/o contrast (70490) $1,200 $2,400 11.9×
CT thoracic spine w contrast (72129) $1,300 $2,600 7.7×
CT thoracic spine w/o contrast (72128) $1,200 $2,400 11.9×
CT thoracic spine w/wo cont (72130) $1,800 $3,600 10.7×
CT thorax w/o contrast (71250) $1,200 $2,400 11.9×
CT upper ext wo (73200) $1,200 $2,400 11.9×
CT upper extremity w/o & w/contrast material (73202) $1,800 $3,600 10.7×
CT upper extremity with contrast (73201) $1,300 $2,600 3.9×
Foot 2 views (73620) $112 $224 1.3×
Forearm 2 views (73090) $112 $224 1.3×
Hand 2 views (73120) $158 $315 1.6×
Knee 3 Views (73562) $112 $224 1.3×
Magnetic Image Jaw Joint (70336) $628 $1,255 2.7×
MRI abdomen w contrast (74182) $1,214 $2,427 3.6×
MRI abdomen w/o contrast (74181) $1,214 $2,427 5.3×
MRI any jt lower extrem w/contrast material (73722) $787 $1,574 1.0×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $1,140 $2,279 3.4×
MRI any jt upper extremity w/contrast matrl (73222) $750 $1,499 1.0×
MRI bone marrow blood supply (77084) $1,018 $2,035 4.4×
MRI cardiac w/o contrast (75557) $1,018 $2,035 4.4×
MRI cervical spine w contrast (72142) $1,400 $2,800 4.2×
MRI cervical spine w/o cont (72141) $1,300 $2,600 5.7×
MRI chest w/o contrast (71550) $1,300 $2,600 5.7×
MRI chest with contrast (71551) $1,400 $2,800 1.9×
MRI chest wo w contrast (71552) $1,950 $3,900 5.8×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $1,018 $2,035 3.0×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $1,160 $2,319 3.5×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $1,018 $2,035 4.4×
MRI lumbar spine w contrast (72149) $1,400 $2,800 4.2×
Mri Neck Spine W/O & W/Dye (72156) $1,950 $3,900 5.8×
MRI orbit face &/neck w/o contrast (70540) $1,300 $2,600 5.7×
MRI orbit face neck w contrast (70542) $1,400 $2,800 4.2×
Mri Orbt/Fac/Nck W/O &W/Dye (70543) $1,950 $3,900 5.8×
MRI pelvis w contrast (72196) $1,018 $2,035 3.0×
MRI pelvis w/o & w contrast (72197) $1,187 $2,373 3.5×
MRI pelvis w/o contrast (72195) $1,018 $2,035 4.4×
MRI spectroscopy (76390) $1,018 $2,035 12.2×
MRI thoracic spine w/o contrast (72146) $1,300 $2,600 5.7×
MRI upper extremity oth than jt w/contr matrl (73219) $1,018 $2,035 3.0×
MRI upper extremity oth than jt w/o contr matrl (73218) $1,018 $2,035 4.4×
Mri Uppr Extremity W/O&W/Dye (73220) $1,125 $2,250 3.4×
MRI, abdomen, combo (74183) $1,214 $2,427 3.6×
MRI, dorsal spine combo (72157) $1,950 $3,900 5.8×
MRI, dorsal spine contrast (72147) $1,400 $2,800 4.2×
MRI, joint upper extrem (73221) $686 $1,372 3.0×
MRI, joint upper extrem combo (73223) $1,085 $2,170 3.2×
MRI, lumbar spine combo (72158) $1,117 $2,234 3.3×
Neck soft tissue (70360) $168 $336 2.0×
Nm red cell survival study (78130) $2 $3 0.0×
Pelvis 1 or 2 views (72170) $141 $281 1.4×
Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) $2 $3 0.0×
Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) $141 $281 1.4×
Radex Ankle Complete Minimum 3 Views (73610) $112 $224 1.3×
Radex Calcaneus Minimum 2 Views (73650) $112 $224 1.3×
Radex Facial Bones Complete Minimum 3 Views (70150) $224 $448 2.2×
Radex fingr minimum 2 views (73140) $112 $224 1.3×
Radex foot complete minimum 3 views (73630) $112 $224 1.3×
Radex Hand Minimum 3 Views (73130) $112 $224 1.3×
Radex Nasal Bones Complete Minimum 3 Views (70160) $112 $224 1.3×
Radex Ribs Unilateral 2 Views (71100) $112 $224 1.3×
Radex shoulder complete minimum 2 views (73030) $168 $336 2.0×
Radex Sternum Minimum 2 Views (71120) $112 $224 1.3×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $112 $224 1.3×
Radex Toe Minimum 2 Views (73660) $112 $224 1.3×
Radex Wrist Complete Minimum 3 Views (73110) $112 $224 1.3×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $141 $281 1.4×
Radiologic exam knee complete 4/more views (73564) $224 $448 2.2×
Radiologic exam pelvis compl minimum 3 views (72190) $141 $281 1.4×
Radiologic examination femur minimum 2 views (73552) $112 $224 1.3×
Radiologic examination knee 1/2 views (73560) $112 $224 1.3×
Radiologic examination tibia & fibula 2 views (73590) $112 $224 1.3×
Radiologic examination, teeth; single view Non-Facility (70300) $38 $75 0.5×
Red Cell Volume Determination Spx 1 Sampling (78120) $2 $3 0.0×
Ribs bilateral 3 views (71110) $168 $336 1.7×
Scapula (73010) $141 $281 1.4×
Shoulder 1 view (73020) $112 $224 1.3×
Sialogram (70390) $25 $50 0.1×
Skull less than 4 views (70250) $196 $392 1.9×
Sternoclavicular joints (71130) $112 $224 1.3×
Thoracic spine 2 views (72070) $168 $336 1.7×
Thoracic spine 3 views (72072) $196 $392 1.9×
Ultrasound, abdomen limited (76705) $259 $518 2.6×
Us pelvic non ob complete (76856) $259 $518 2.6×
Us retroperitoneal complete (76770) $259 $518 2.6×
Us retroperitoneal limited (76775)
range across 6 matching MRF lines		 $217–$2,559 $433–$5,118 varies
Wrist 2 views (73100) $112 $224 1.3×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $112 $224 1.3×
X-Ray Bend Only L-S Spine (72120) $168 $336 1.7×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $112 $224 1.3×
X-Ray Exam Hip Uni 1 View (73501) $112 $224 1.3×
X-Ray Exam Hip Uni 2-3 Views (73502) $112 $224 1.3×
X-Ray Exam Hips Bi 2 Views (73521) $141 $281 1.4×
X-Ray Exam Neck Spine 2-3 Vw (72040) $112 $224 1.3×
X-Ray Exam Neck Spine 6/>Vws (72052) $168 $336 1.7×
X-Ray Exam Unilat Ribs/Chest (71101)
range across 4 matching MRF lines		 $2–$17 $3–$33 varies
X-ray humerus (73060) $112 $224 1.3×
X-ray IV pyelogram (ivp) (74400) $612 $1,223 3.6×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $112 $224 1.3×
X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) $141 $281 1.4×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $112 $224 1.3×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $112 $224 1.3×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $224 $448 2.2×
X-ray thoracic spine 4 vw (72074) $224 $448 2.2×
Xr c-spine 4 or 5 views (72050) $168 $336 1.7×
XR Mastoids < 3 Views Bilateral (70120) $196 $392 1.9×
Xr orbits complete 4 views (70200) $168 $336 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.