Choctaw Memorial Hospital

1405 East Kirk Road, Hugo, OK 74743 · (580) 317-9500

Acute Care HospitalsVoluntary non-profit - OtherCMS rating 1/5Website ↗

Price file

Prices published

File dated 2026-04-01

277 price rows for 37 procedures

Published prices

cash · negotiated range · list

Basic metabolic panel (blood test)

CPT 80048

$62

cash

$8 to $11

2 negotiated rates

$124

list

CT scan of the abdomen and pelvis, with contrast

CPT 74177

$1,502

cash

$275 to $428

2 negotiated rates

$3,004

list

CT scan of the head, no contrast

CPT 70450

$790

cash

$149 to $275

2 negotiated rates

$1,580

list

CT scan of the pelvis, with contrast

CPT 72193

$1,030

cash

$275 to $318

2 negotiated rates

$2,059

list

Chlamydia test (DNA)

CPT 87491

$95

cash

$36 to $44

2 negotiated rates

$189

list

Colonoscopy (diagnostic)

CPT 45378

$983

cash

$234 to $234

1 negotiated rates

$1,965

list

Colonoscopy with biopsy

CPT 45380

$1,065

cash

$255 to $255

1 negotiated rates

$2,130

list

Complete blood count (CBC) with differential

CPT 85025 · lowest of 2 lines

$30

cash

$8 to $10

4 negotiated rates

$60

list

Comprehensive metabolic panel (blood test)

CPT 80053

$88

cash

$8 to $13

2 negotiated rates

$176

list

Diagnostic mammogram (both breasts)

CPT 77066 · lowest of 3 lines

$45

cash

$72 to $214

6 negotiated rates

$90

list

Established patient office visit (about 40 minutes)

CPT 99215

$219

cash

$167 to $167

1 negotiated rates

$438

list

Gallbladder removal (laparoscopic)

CPT 47562

$6,299

cash

$843 to $843

1 negotiated rates

$12,598

list

Gonorrhea test (DNA)

CPT 87591

$95

cash

$36 to $44

2 negotiated rates

$189

list

Hospital stay for digestive disorders, no complications

MS-DRG 392

$3,224

cash

$1,475 to $3,044

2 negotiated rates

$6,447

list

Inguinal hernia repair (age 5 and up)

CPT 49505

$4,295

cash

$668 to $668

1 negotiated rates

$8,589

list

Lipid panel (cholesterol test)

CPT 80061

$77

cash

$13 to $17

2 negotiated rates

$153

list

Liver function panel

CPT 80076 · lowest of 2 lines

$79

cash

$8 to $10

4 negotiated rates

$157

list

Nerve block injection, lower back, with imaging guidance

CPT 64483 · lowest of 2 lines

$165

cash

$141 to $141

2 negotiated rates

$330

list

New patient office visit (about 30 minutes)

CPT 99203

$164

cash

$97 to $97

1 negotiated rates

$327

list

New patient office visit (about 45 minutes)

CPT 99204

$249

cash

$156 to $156

1 negotiated rates

$498

list

New patient office visit (about 60 minutes)

CPT 99205

$312

cash

$211 to $211

1 negotiated rates

$624

list

PSA test (prostate)

CPT 84153 · lowest of 2 lines

$42

cash

$18 to $23

4 negotiated rates

$83

list

Partial thromboplastin time (blood clotting test)

CPT 85730

$22

cash

$6 to $8

2 negotiated rates

$44

list

Pregnancy ultrasound (after first trimester)

CPT 76805

$202

cash

$80 to $185

2 negotiated rates

$404

list

Preventive visit, new patient age 18 to 39

CPT 99385

$100

cash

$130 to $130

1 negotiated rates

$200

list

Preventive visit, new patient age 40 to 64

CPT 99386

$100

cash

$158 to $158

1 negotiated rates

$200

list

Prothrombin time (blood clotting test)

CPT 85610

$19

cash

$4 to $5

2 negotiated rates

$37

list

Screening mammogram (both breasts)

CPT 77067 · lowest of 5 lines

$35

cash

$72 to $173

10 negotiated rates

$70

list

Spinal injection, lower back, with imaging guidance

CPT 62323 · lowest of 2 lines

$149

cash

$127 to $127

2 negotiated rates

$298

list

TSH test (thyroid)

CPT 84443 · lowest of 2 lines

$57

cash

$17 to $21

4 negotiated rates

$113

list

Tonsils and adenoids removal (under age 12)

CPT 42820

$6,197

cash

$374 to $374

1 negotiated rates

$12,393

list

Transvaginal ultrasound

CPT 76830

$202

cash

$80 to $162

2 negotiated rates

$404

list

Ultrasound of the abdomen (complete)

CPT 76700

$310

cash

$80 to $159

2 negotiated rates

$619

list

Upper endoscopy (EGD)

CPT 43235

$1,500

cash

$155 to $155

1 negotiated rates

$3,000

list

Upper endoscopy with biopsy

CPT 43239

$1,500

cash

$175 to $175

1 negotiated rates

$3,000

list

Urinalysis with microscope

CPT 81001

$21

cash

$3 to $4

2 negotiated rates

$42

list

X-ray of the lower spine (4 or more views)

CPT 72110

$170

cash

$55 to $69

2 negotiated rates

$339

list

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.

https://choctawmemorial.com/wp-content/uploads/2026/04/736060815_choctaw-county-city-of-hugo-hospital-trust-authority-_standardcharges.csv
Choctaw Memorial Hospital · discovered · tall v3.0.0 · file dated 2026-04-01 · 4.2 MB · 277 price rows read · read Sep 2026