Sanford Sheldon Medical Center
118 N 7th Ave, Sheldon, IA · Sanford Health · · NPI 1841200623
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Kidney img w/bldflw sgl without rx CPT 78707 | $1,980.80 | $2,476.00 | $705.66 – $2,228.40 | 15 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $820.00 | $1,025.00 | $292.13 – $922.50 | 15 |
| Kidney (Retroperitoneal) Ultrasound (limited) CPT 76775 | $700.00 | $875.00 | $249.38 – $787.50 | 15 |
| Knee MRI (with and without contrast) CPT 73723 | $4,069.60 | $5,087.00 | $1,449.80 – $4,578.30 | 15 |
| Knee MRI (with contrast) CPT 73722 | $3,324.00 | $4,155.00 | $1,184.18 – $3,739.50 | 15 |
| Knee MRI (without contrast) CPT 73721 | $2,810.40 | $3,513.00 | $1,001.21 – $3,161.70 | 15 |
| Knee X-ray CPT 73564 | $413.60 | $517.00 | $147.35 – $465.30 | 15 |
| Knee X-ray (1 to 2 views, both knees) CPT 73560 | $309.60 | $387.00 | $110.30 – $348.30 | 15 |
| Knee X-ray (3 views, both knees) CPT 73562 | $363.20 | $454.00 | $129.39 – $408.60 | 15 |
| Knee X-ray (standing, both knees) CPT 73565 | $316.00 | $395.00 | $112.58 – $355.50 | 15 |
| Ko elastic w/joints pre ots HCPCS L1812 | $75.20 | $94.00 | $16.25 – $51.30 | 15 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $64.79 | $80.98 | $21.46 – $67.76 | 15 |
| Lacosamide 200 mg/20 ml intravenous solution HCPCS C9254 | $70.14 | $87.67 | $22.63 – $71.45 | 15 |
| Lactate dehydrogenase (ldh) CPT 83615 | $44.80 | $56.00 | $15.96 – $50.40 | 15 |
| Lactated ringers intravenous solution HCPCS J7120 | $40.00 | $50.00 | $14.25 – $45.00 | 15 |
| Lactic acid CPT 83605 | $94.40 | $118.00 | $33.63 – $106.20 | 15 |
| Lactoferrin fecal qualitative CPT 83630 | $140.00 | $175.00 | $49.88 – $157.50 | 15 |
| Laparoscopy remove adnexa CPT 58661 | $11,330.40 | $14,163.00 | $4,036.46 – $12,746.70 | 15 |
| Large Joint Injection or Fluid Draw (both sides) CPT 20610 | $798.40 | $998.00 | $185.25 – $585.00 | 15 |
| Laronidase injection HCPCS J1931 | not published | not published | $39.41 – $39.41 | 1 |
| Lead capillary CPT 83655 | $100.80 | $126.00 | $10.83 – $34.20 | 15 |
| Leg Artery Ultrasound (complete, both legs) CPT 93925 | $1,267.20 | $1,584.00 | $451.44 – $1,425.60 | 15 |
| Leg CT Scan (with contrast, both legs) CPT 73701 | $2,360.80 | $2,951.00 | $841.04 – $2,655.90 | 15 |
| Leg CT Scan (without contrast, both legs) CPT 73700 | $2,018.40 | $2,523.00 | $719.06 – $2,270.70 | 15 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,337.60 | $1,672.00 | $476.52 – $1,504.80 | 15 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $520.00 | $650.00 | $185.25 – $585.00 | 15 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $74.84 | $93.55 | $26.06 – $82.31 | 15 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $4,396.20 | $5,495.25 | $134.13 – $423.58 | 15 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $17,562.40 | $21,953.00 | $522.10 – $1,648.75 | 15 |
| Levalbuterol non-comp unit HCPCS J7614 | $5.82 | $7.27 | $1.86 – $5.88 | 15 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $63.60 | $79.49 | $21.72 – $68.59 | 15 |
| Levetiracetam therapeutic drug level CPT 80177 | $107.20 | $134.00 | $38.19 – $120.60 | 15 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $119.51 | $149.38 | $26.50 – $83.68 | 15 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $191.67 | $239.58 | $68.28 – $215.62 | 15 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $63.56 | $79.45 | $6.84 – $21.60 | 15 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $77.27 | $96.58 | $26.96 – $85.12 | 15 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | $4,917.60 | $6,147.00 | $1,751.90 – $5,532.30 | 15 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $220.43 | $275.53 | $42.06 – $132.82 | 15 |
| Lipase CPT 83690 | $51.20 | $64.00 | $18.24 – $57.60 | 15 |
| Lipoprotein direct measurement hdl CPT 83718 | $66.40 | $83.00 | $23.66 – $74.70 | 15 |
| Lipoprotein direct measurement ldl CPT 83721 | $66.40 | $83.00 | $23.66 – $74.70 | 15 |
| Lithium therapeutic drug level CPT 80178 | $60.00 | $75.00 | $21.38 – $67.50 | 15 |
| Liver Function Test CPT 80076 | $61.60 | $77.00 | $21.95 – $69.30 | 15 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $62.52 | $78.15 | $21.52 – $67.97 | 15 |
| Lo sag rig pnl stays pre cst HCPCS L0626 | $152.80 | $191.00 | $54.44 – $171.90 | 15 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $3,097.60 | $3,872.00 | $1,103.52 – $3,484.80 | 15 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $2,491.20 | $3,114.00 | $887.49 – $2,802.60 | 15 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,508.00 | $3,135.00 | $893.48 – $2,821.50 | 15 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $4,326.40 | $5,408.00 | $1,541.28 – $4,867.20 | 15 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $3,452.80 | $4,316.00 | $1,230.06 – $3,884.40 | 15 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $3,165.60 | $3,957.00 | $1,127.75 – $3,561.30 | 15 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $414.40 | $518.00 | $147.63 – $466.20 | 15 |
| Lower Back (Lumbar Spine) X-ray (4 or more views) CPT 72110 | $562.40 | $703.00 | $200.36 – $632.70 | 15 |
| Lower Back (Lumbar Spine) X-ray (with bending views) CPT 72114 | $652.80 | $816.00 | $232.56 – $734.40 | 15 |
| Lower Leg (Shin) X-ray (both sides) CPT 73590 | $332.00 | $415.00 | $118.28 – $373.50 | 15 |
| Lumizyme injection HCPCS J0221 | not published | not published | $205.76 – $205.76 | 1 |
| Lung Function Test Before and After an Inhaler CPT 94060 | $679.20 | $849.00 | $241.97 – $764.10 | 15 |
| Lung function test (mbc/mvv) CPT 94200 | $235.20 | $294.00 | $83.79 – $264.60 | 15 |
| Lung Function Test (Spirometry) CPT 94010 | $399.20 | $499.00 | $142.22 – $449.10 | 15 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | not published | not published | $41.40 – $41.40 | 1 |
| Macroscopic exam arthropod CPT 87168 | $80.00 | $100.00 | $28.50 – $90.00 | 15 |
| Magnesium CPT 83735 | $50.40 | $63.00 | $17.96 – $56.70 | 15 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $76.87 | $96.08 | $21.41 – $67.63 | 15 |
| Makena, 10 mg HCPCS J1726 | $633.16 | $791.44 | $91.79 – $289.85 | 15 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | $60.76 | $75.95 | $21.65 – $68.36 | 15 |
| Marker biop eviva buckle ss HCPCS A4648 | $198.40 | $248.00 | $70.68 – $223.20 | 15 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $153.60 | $192.00 | $54.72 – $172.80 | 15 |
| Mayo aathr protein s free CPT 85306 | $348.80 | $436.00 | $124.26 – $392.40 | 15 |
| Mayo activated protein c resistance assay CPT 85307 | $153.60 | $192.00 | $54.72 – $172.80 | 15 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $69.60 | $87.00 | $16.53 – $52.20 | 15 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $50.40 | $63.00 | $17.96 – $56.70 | 15 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $88.80 | $111.00 | $31.64 – $99.90 | 15 |
| Mayo alpha 1 antitrypsin CPT 82103 | $125.60 | $157.00 | $39.90 – $126.00 | 15 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $101.60 | $127.00 | $36.20 – $114.30 | 15 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $58.40 | $73.00 | $20.81 – $65.70 | 15 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $73.60 | $92.00 | $26.22 – $82.80 | 15 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $440.00 | $550.00 | $156.75 – $495.00 | 15 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $476.00 | $595.00 | $89.21 – $281.70 | 15 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $3,050.40 | $3,813.00 | $163.88 – $517.50 | 15 |
| Mayo androstenedione CPT 82157 | $68.80 | $86.00 | $24.51 – $77.40 | 15 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $134.40 | $168.00 | $47.31 – $149.40 | 15 |
| Mayo antithrombin iii antigen CPT 85301 | $117.60 | $147.00 | $41.90 – $132.30 | 15 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $69.60 | $87.00 | $11.12 – $35.10 | 15 |
| Mayo avwpr vw factor activity CPT 85397 | $272.00 | $340.00 | $96.90 – $306.00 | 15 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $144.00 | $180.00 | $51.30 – $162.00 | 15 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $84.00 | $105.00 | $29.07 – $91.80 | 15 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $97.60 | $122.00 | $34.77 – $109.80 | 15 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $114.40 | $143.00 | $40.76 – $128.70 | 15 |
| Mayo c1 esterase inhibitor CPT 83883 | $132.00 | $165.00 | $12.54 – $39.60 | 15 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $224.00 | $280.00 | $79.80 – $252.00 | 15 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $50.40 | $63.00 | $17.96 – $56.70 | 15 |
| Mayo ceruloplasmin CPT 82390 | $86.40 | $108.00 | $30.78 – $97.20 | 15 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $127.20 | $159.00 | $12.83 – $40.50 | 15 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $102.40 | $128.00 | $11.69 – $36.90 | 15 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $54.40 | $68.00 | $19.38 – $61.20 | 15 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $54.40 | $68.00 | $19.38 – $61.20 | 15 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $296.00 | $370.00 | $105.45 – $333.00 | 15 |
| Mayo chromium CPT 82495 | $59.20 | $74.00 | $21.09 – $66.60 | 15 |
| Mayo coccidioides antibody CPT 86635 | $102.40 | $128.00 | $32.21 – $101.70 | 15 |
| Mayo cocou cortisone urine CPT 82542 | $154.40 | $193.00 | $55.01 – $173.70 | 15 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.